Healthcare Provider Details

I. General information

NPI: 1538005293
Provider Name (Legal Business Name): LONGEVITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 JEROME PRAIRIE RD
GRANTS PASS OR
97527-9156
US

IV. Provider business mailing address

PO BOX 653
MURPHY OR
97533-0653
US

V. Phone/Fax

Practice location:
  • Phone: 541-660-2791
  • Fax:
Mailing address:
  • Phone:
  • 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: ASHLEY PHAIGH
Title or Position: OWNER
Credential: LMT
Phone: 541-660-2791