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Organization
VITAL LIVING THERAPEUTIC MASSAGE, LLC
Active
Organization
VITAL LIVING THERAPEUTIC MASSAGE, LLC
Active
Other names
Vital Living WellSpa
Organization subpart
No
Provider details
NPI number
Authorized official
JANET CARROLL (OWNER)
(260) 436-8807
Entity
Organization
Contact information
Practice address
5111 N BEND DR, FORT WAYNE, IN 46804-1753
(260) 436-8807
(260) 436-2767
Mailing address
5111 N BEND DR, FORT WAYNE, IN 46804-1753
(260) 436-8807
(260) 436-2767
Taxonomy
Speciality
Code
Description
License number
State
163WM1400X
Nurse Massage Therapist (NMT)
Primary
28057959A
IN
225700000X
Massage Therapist
MT20901877
IN
Other
Enumeration date
08/19/2015
Last updated
08/19/2015
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