Provider Demographics
NPI:1184879751
Name:A BRIDGE TO WELLNESS, INC.
Entity type:Organization
Organization Name:A BRIDGE TO WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:VIGEANT
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-993-0599
Mailing Address - Street 1:815 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2713
Mailing Address - Country:US
Mailing Address - Phone:360-993-0599
Mailing Address - Fax:360-695-0378
Practice Address - Street 1:316 E FOURTH PLAIN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3074
Practice Address - Country:US
Practice Address - Phone:360-993-0599
Practice Address - Fax:360-695-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA20866225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty