MEDICARE: HEART FLOW MASSAGE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	261QP3300X	Pain Clinic/Center
3	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1720764756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART FLOW MASSAGE LLC

Provider Business Mailing Address
First Line	:	1916 MEADOWLARK DR NE
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-1955
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 COMMERCIAL ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3416
Country	:	US
Telephone Number	:	971-217-8370
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PROVIDER
Name	:	GENEVIEVE DAUGHERTY
Credential	:	LMT, CMLDT
Telephone Number	:	917-597-5829

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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Directions to “HEART FLOW MASSAGE LLC ” Practice Location

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