Healthcare Provider Details

I. General information

NPI: 1265880181
Provider Name (Legal Business Name): TWO SUNS MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9123 SE SAINT HELENS ST STE 275
CLACKAMAS OR
97015-6858
US

IV. Provider business mailing address

9123 SE SAINT HELENS ST STE 275
CLACKAMAS OR
97015-6858
US

V. Phone/Fax

Practice location:
  • Phone: 503-449-5164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1501203397
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17680
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13868
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17528
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ASHA R POWELL-STORMBERG
Title or Position: OWNER
Credential: LMT
Phone: 503-449-5164