Healthcare Provider Details

I. General information

NPI: 1760760532
Provider Name (Legal Business Name): MEDICAL MASSAGE N.W. L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8655 SW CITIZENS DR SUITE 206
WILSONVILLE OR
97070-7475
US

IV. Provider business mailing address

8655 SW CITIZENS DR SUITE 206
WILSONVILLE OR
97070-7475
US

V. Phone/Fax

Practice location:
  • Phone: 503-516-5354
  • Fax:
Mailing address:
  • Phone: 503-516-5354
  • 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: MS. NICOLE MICHELLE SANDERS
Title or Position: OWNER/ LMT
Credential: L.M.T
Phone: 503-516-5354