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NPI Code Detail

MEDICARE: BODY ALTAR

MEDICARE: BODY ALTAR
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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1841845732
Entity Type Code : Organization
Provider Name (Legal Business Name) : BODY ALTAR
Provider Business Mailing Address
First Line : 6948 N MONTANA AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97217-5432
Country : US
Telephone Number : 415-515-6152
Fax Number :
Provider Business Practice Location Address
First Line : 443 NE KNOTT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97212-3108
Country : US
Telephone Number : 503-941-0152
Fax Number : 503-282-1070
Authorized Official
Title or Position : OWNER
Name : ANDREA BLUM
Credential : LMT
Telephone Number : 415-515-6152
Provider Enumeration Date : 08/07/2019
Last Update Date : 08/07/2019

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Directions to “BODY ALTAR ” Practice Location

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