Healthcare Provider Details

I. General information

NPI: 1932003365
Provider Name (Legal Business Name): DAVID HARRIES LMT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 18TH ST STE 5
SPRINGFIELD OR
97477-4200
US

IV. Provider business mailing address

1110 18TH ST STE 5
SPRINGFIELD OR
97477-4200
US

V. Phone/Fax

Practice location:
  • Phone: 541-954-4816
  • Fax: 541-357-4291
Mailing address:
  • Phone: 541-954-4816
  • Fax: 541-357-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID HARRIES
Title or Position: OWNER
Credential: LMT
Phone: 541-954-4816