Provider Demographics
NPI:1548504970
Name:MAY VIGIL, SANDY M (LMT)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:M
Last Name:MAY VIGIL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SE PARK CREST AVE STE A120
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1303
Mailing Address - Country:US
Mailing Address - Phone:360-892-3654
Mailing Address - Fax:360-892-3692
Practice Address - Street 1:225 SECOND ST
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648
Practice Address - Country:US
Practice Address - Phone:509-427-4266
Practice Address - Fax:360-892-3692
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA 00019540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist