Healthcare Provider Details

I. General information

NPI: 1912810326
Provider Name (Legal Business Name): SUMMIT BODY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 SW HAMPTON ST STE 140
TIGARD OR
97223-8375
US

IV. Provider business mailing address

8700 SW ASH MEADOWS RD APT 1031
WILSONVILLE OR
97070-4058
US

V. Phone/Fax

Practice location:
  • Phone: 775-420-1027
  • Fax:
Mailing address:
  • Phone: 775-420-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: SAVHANNAH E BOURISAW
Title or Position: OWNER/LMT
Credential: LMT
Phone: 775-420-1027