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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