Healthcare Provider Details

I. General information

NPI: 1881235745
Provider Name (Legal Business Name): BALANCED MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 E MAIN ST STE 1
MEDFORD OR
97504-7115
US

IV. Provider business mailing address

836 E MAIN ST STE 1
MEDFORD OR
97504-7115
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-9324
  • Fax:
Mailing address:
  • Phone: 541-773-9324
  • 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: CARA WIRT
Title or Position: OWNER, MANAGER
Credential: LMT
Phone: 541-773-9324