MEDICARE: BALANCE MASSAGE THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	8039	OR

General Provider Information

NPI Number	:	1669777298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE MASSAGE THERAPY, LLC

Provider Business Mailing Address
First Line	:	1010 12TH ST
Second Line	:	SUITE B
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1534
Country	:	US
Telephone Number	:	541-380-0918
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 12TH ST
Second Line	:	SUITE B
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1534
Country	:	US
Telephone Number	:	541-380-0918
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELE PATRICK
Credential	:	LMT
Telephone Number	:	541-380-0918

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	01/12/2011

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