Healthcare Provider Details

I. General information

NPI: 1902441736
Provider Name (Legal Business Name): EARTHTOUCH MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 NW HILL ST STE 6
BEND OR
97703-2902
US

IV. Provider business mailing address

888 NW HILL ST STE 6
BEND OR
97703-2902
US

V. Phone/Fax

Practice location:
  • Phone: 541-420-0644
  • Fax: 541-706-9230
Mailing address:
  • Phone: 541-420-0644
  • Fax: 541-706-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: HANNAH REED
Title or Position: OWNER
Credential:
Phone: 541-420-0644