Provider Demographics
NPI:1902628340
Name:DEXTERITY SPA AND MASSAGE
Entity type:Organization
Organization Name:DEXTERITY SPA AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASHCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-236-4426
Mailing Address - Street 1:780 MOONFLOWER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3184
Mailing Address - Country:US
Mailing Address - Phone:971-236-4426
Mailing Address - Fax:
Practice Address - Street 1:880 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4108
Practice Address - Country:US
Practice Address - Phone:971-236-4426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty