Healthcare Provider Details

I. General information

NPI: 1609250075
Provider Name (Legal Business Name): RENAISSANCE THERAPEUTIC MASSAGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W 8TH AVE
EUGENE OR
97401-2901
US

IV. Provider business mailing address

35 W 8TH AVE
EUGENE OR
97401-2901
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-4461
  • Fax: 541-686-4465
Mailing address:
  • Phone: 541-686-4461
  • Fax: 541-686-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number19124
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ANNMARIE LOUISE MAURER
Title or Position: PRESIDENT
Credential: LMT
Phone: 541-686-4461