Healthcare Provider Details

I. General information

NPI: 1053712018
Provider Name (Legal Business Name): BELLA VIDA MASSAGE & BODYWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S 1ST ST
SAINT HELENS OR
97051-2003
US

IV. Provider business mailing address

239 S 1ST ST
SAINT HELENS OR
97051-2003
US

V. Phone/Fax

Practice location:
  • Phone: 503-396-9617
  • Fax:
Mailing address:
  • Phone: 503-396-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number14160
License Number StateOR

VIII. Authorized Official

Name: ELIZABETH ANNE ROBBINS
Title or Position: OWNER/MASSAGE THERAPIST
Credential: LMT
Phone: 503-396-9617