Provider Demographics
NPI:1982234258
Name:VITALITY MASSAGE STUDIO
Entity Type:Organization
Organization Name:VITALITY MASSAGE STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPISTS
Authorized Official - Prefix:
Authorized Official - First Name:LORIAN
Authorized Official - Middle Name:ALESHIA
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:786-438-6642
Mailing Address - Street 1:8864 SW 129TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5931
Mailing Address - Country:US
Mailing Address - Phone:786-438-6642
Mailing Address - Fax:
Practice Address - Street 1:8864 SW 129TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5931
Practice Address - Country:US
Practice Address - Phone:786-438-6642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA87359OtherB500-521-88-757-1