VITAL LIVING THERAPEUTIC MASSAGE, LLC (NPI# 1790151157) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790151157 |
| Entity Type | Organization |
| Organization Name | VITAL LIVING THERAPEUTIC MASSAGE, LLC |
| Other Organization Name | VITAL LIVING WELLSPA |
| Practice Address |
5111 N Bend Dr Fort Wayne IN 46804-1753 |
| Practice Telephone | 2604368807 |
| Practice Fax Number | 2604362767 |
| Mailing Telephone | 2604368807 |
| Mailing Fax Number | 2604362767 |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |
| Authorized Official Name | JANET CARROLL (OWNER) |
| Authorized Official Telephone | 2604368807 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225700000X | Massage Therapist | MT20901877 | IN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 163WM1400X |
Registered Nurse Specialization: Nurse Massage Therapist (NMT) |
28057959A | IN | Nursing Service Providers |
| Other Name | Type Code |
|---|---|
| Vital Living WellSpa | Doing Business As Name - Organization |
| Street Address |
5111 N BEND DR |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-1753 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851775209 | Stephanie Florin | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2015-07-15 |
| 1992339444 | Amy Prince | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2020-02-24 |
| 1366086225 | Megan Gurney | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2019-11-04 |
| 1093364960 | Chelsey Lynn Gilbert | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2019-09-04 |
| 1790250777 | Marsharika Emani Coleman | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2018-10-05 |
| 1033614235 | Terrie Lynne Hayes | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2018-03-28 |
| 1225579147 | Bobbie Jean Baxter | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2017-03-10 |
| 1073982690 | Kristen Wolf | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2015-09-24 |
| 1770952053 | Luecinda M Moser | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2015-09-17 |
| 1083081400 | Lauren Reese | Massage Therapist | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2015-09-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 163WM1400X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Nurse Massage Therapist (NMT) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124494505 | Janet Carroll | Registered Nurse | 5111 N Bend Dr, Fort Wayne, IN 46804-1753 | 2015-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760709554 | Debra Vierling | Registered Nurse | 691 Tekulve Rd, Batesville, IN 47006-8982 | 2010-05-03 |
| 1891978433 | Myra Leann Swintz | Registered Nurse | 904 Ramblin Rd, Greenwood, IN 46142-8356 | 2007-12-05 |
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on VITAL LIVING THERAPEUTIC MASSAGE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.