Healthcare Provider Details

I. General information

NPI: 1720764756
Provider Name (Legal Business Name): HEART FLOW MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 PLYMOUTH DR NE STE 101
KEIZER OR
97303-5049
US

IV. Provider business mailing address

1916 MEADOWLARK DR NE
KEIZER OR
97303-1955
US

V. Phone/Fax

Practice location:
  • Phone: 971-217-8370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GENEVIEVE DAUGHERTY
Title or Position: OWNER, PROVIDER
Credential: LMT, CMLDT
Phone: 917-597-5829