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General NPI Number Information
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NPI Number | 1124485792
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Entity Type | Organization
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Legal Business Name | MIND BODY ROLFING
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 1639 OAK ST SUITE D
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City | EUGENE
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State | OR
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Zip | 97401-4088
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Country | US
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Telephone | 541-246-4912
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1603
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City | EUGENE
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State | OR
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Zip | 97440-1603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CERTIFIED ROLFER
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Name | MS. JESSICA MARIE TERRILL
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Credential | LMT
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Telephone | 541-246-4912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21629
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License Number State | OR
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