Provider Demographics
NPI:1154750321
Name:VITALITY GROUP OF WNY
Entity type:Organization
Organization Name:VITALITY GROUP OF WNY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:239-269-3279
Mailing Address - Street 1:2338 IMMOKALEE RD
Mailing Address - Street 2:#105
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1445
Mailing Address - Country:US
Mailing Address - Phone:239-269-3279
Mailing Address - Fax:
Practice Address - Street 1:3670 MCKINLEY PKWY
Practice Address - Street 2:MASSAGE ENVY
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-2696
Practice Address - Country:US
Practice Address - Phone:716-822-3689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21MA1407640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty