Healthcare Provider Details

I. General information

NPI: 1114800240
Provider Name (Legal Business Name): REROOT MASSAGE THERAPY AND ENERGY WORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W OREGON AVE
CRESWELL OR
97426-9259
US

IV. Provider business mailing address

527 PEBBLE BEACH DR
CRESWELL OR
97426-9882
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-8333
  • Fax: 541-895-3359
Mailing address:
  • Phone: 916-835-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ROOPKIRAN KAUR
Title or Position: OWNER/MANAGER, LMT
Credential: LMT, RD
Phone: 541-357-8333