Healthcare Provider Details

I. General information

NPI: 1801003553
Provider Name (Legal Business Name): BODY JAZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2868 WILLAMETTE ST
EUGENE OR
97405-7209
US

IV. Provider business mailing address

2868 WILLAMETTE ST
EUGENE OR
97405-7209
US

V. Phone/Fax

Practice location:
  • Phone: 541-868-1575
  • Fax: 541-868-1577
Mailing address:
  • Phone: 541-868-1575
  • Fax: 541-868-1577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: RONALD E TINSLEY
Title or Position: OWNER
Credential:
Phone: 541-868-1575