Healthcare Provider Details

I. General information

NPI: 1376867366
Provider Name (Legal Business Name): HANDS ON HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2169 NW NORTHRUP ST
PORTLAND OR
97210-2916
US

IV. Provider business mailing address

2169 NW NORTHRUP ST
PORTLAND OR
97210-2916
US

V. Phone/Fax

Practice location:
  • Phone: 503-502-5001
  • Fax: 503-502-5001
Mailing address:
  • Phone: 503-502-5001
  • Fax: 503-502-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00627
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5722
License Number StateOR

VIII. Authorized Official

Name: ELLA ROGGOW
Title or Position: ACUPUNCTURIST
Credential: LMT, LAC
Phone: 503-502-5001