Healthcare Provider Details

I. General information

NPI: 1184169401
Provider Name (Legal Business Name): LLADRO MASSAGE AND BODYWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LIBERTY ST SE SUITE 2
SALEM OR
97302-4154
US

IV. Provider business mailing address

1100 LIBERTY ST SE SUITE 2
SALEM OR
97302-4154
US

V. Phone/Fax

Practice location:
  • Phone: 503-428-2563
  • Fax:
Mailing address:
  • Phone: 503-428-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13593
License Number StateOR

VIII. Authorized Official

Name: LLADRO FINSTER
Title or Position: OWNER
Credential: LMT
Phone: 503-428-2563