Provider Demographics
NPI:1043727951
Name:MOYERS, VANESSA (LMT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MOYERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:AUSSERESSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1316 NE HIGHWAY 99W
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2723
Mailing Address - Country:US
Mailing Address - Phone:503-434-6603
Mailing Address - Fax:503-434-6746
Practice Address - Street 1:1316 NE HIGHWAY 99W
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2723
Practice Address - Country:US
Practice Address - Phone:503-434-6603
Practice Address - Fax:503-434-6746
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23890225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist