Healthcare Provider Details

I. General information

NPI: 1396160693
Provider Name (Legal Business Name): BIO FOOT REFLEXOLOGY AND MASSAGE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2014
Last Update Date: 02/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 LOWER BOONES FERRY RD STE A
LAKE OSWEGO OR
97035-5398
US

IV. Provider business mailing address

17777 LOWER BOONES FERRY RD STE A
LAKE OSWEGO OR
97035-5398
US

V. Phone/Fax

Practice location:
  • Phone: 503-699-5888
  • Fax:
Mailing address:
  • Phone: 503-699-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MICHAEL ALDEN LEARD
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 503-572-2250