Healthcare Provider Details

I. General information

NPI: 1265094528
Provider Name (Legal Business Name): EVEXIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2019
Last Update Date: 07/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9123 SE SAINT HELENS ST STE 100A
CLACKAMAS OR
97015-6800
US

IV. Provider business mailing address

9123 SE SAINT HELENS ST # 1001A
CLACKAMAS OR
97015-6858
US

V. Phone/Fax

Practice location:
  • Phone: 503-482-2122
  • Fax:
Mailing address:
  • Phone: 503-482-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA MARIE DRAKULICH
Title or Position: OWNER/LMT
Credential: LMT
Phone: 503-482-2122