Healthcare Provider Details

I. General information

NPI: 1154231694
Provider Name (Legal Business Name): RESILIENCE SPRINGFIELD MEDICAL MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 J ST
SPRINGFIELD OR
97477-4251
US

IV. Provider business mailing address

1618 J ST
SPRINGFIELD OR
97477-4251
US

V. Phone/Fax

Practice location:
  • Phone: 541-404-9510
  • Fax: 458-201-7930
Mailing address:
  • Phone: 541-404-9510
  • Fax: 458-201-7930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LACEY J ESTABROOK
Title or Position: OWNER/LMT
Credential: LMT
Phone: 541-404-9510