Healthcare Provider Details

I. General information

NPI: 1114696283
Provider Name (Legal Business Name): MASSAGE ON THE GO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12950 SW PACIFIC HWY STE 115
TIGARD OR
97223-5052
US

IV. Provider business mailing address

12950 SW PACIFIC HWY STE 115
TIGARD OR
97223-5052
US

V. Phone/Fax

Practice location:
  • Phone: 503-620-0724
  • Fax:
Mailing address:
  • Phone: 503-620-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BETH MURRAY
Title or Position: INSURANCE BILLING SPECIALIST
Credential:
Phone: 503-620-0724