Healthcare Provider Details

I. General information

NPI: 1972170132
Provider Name (Legal Business Name): ZACHARY JORDAN WOODS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 NE MCDONALD LN
MCMINNVILLE OR
97128-2702
US

IV. Provider business mailing address

2214 NE MCDONALD LN
MCMINNVILLE OR
97128-2702
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-6603
  • Fax: 503-434-6746
Mailing address:
  • Phone: 503-434-6603
  • Fax: 503-434-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26363
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: