Provider Demographics
NPI:1255385647
Name:BEVERIDGE, VICKY (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:VICKY
Middle Name:
Last Name:BEVERIDGE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 NILES CORTLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2430
Mailing Address - Country:US
Mailing Address - Phone:330-856-3577
Mailing Address - Fax:330-856-1094
Practice Address - Street 1:369 NILES CORTLAND RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2430
Practice Address - Country:US
Practice Address - Phone:330-856-3577
Practice Address - Fax:330-856-1094
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.012773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist