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General NPI Number Information
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NPI Number | 1053712018
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Entity Type | Organization
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Legal Business Name | BELLA VIDA MASSAGE & BODYWORK, LLC
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 239 S 1ST ST
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City | SAINT HELENS
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State | OR
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Zip | 97051-2003
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Country | US
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Telephone | 503-396-9617
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Fax |
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Provider Business Mailing Address
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Address Line | 239 S 1ST ST
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City | SAINT HELENS
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State | OR
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Zip | 97051-2003
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Country | US
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Telephone | 503-396-9617
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Fax |
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Authorized Official
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Title or Position | OWNER/MASSAGE THERAPIST
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Name | ELIZABETH ANNE ROBBINS
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Credential | LMT
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Telephone | 503-396-9617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 14160
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License Number State | OR
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