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General NPI Number Information
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NPI Number | 1245048156
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Entity Type | Organization
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Legal Business Name | TYRELL GROUP
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 910 CAPITOL ST NE
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City | SALEM
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State | OR
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Zip | 97301-1201
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Country | US
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Telephone | 503-851-5518
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Fax |
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Provider Business Mailing Address
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Address Line | 910 CAPITOL ST NE
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City | SALEM
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State | OR
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Zip | 97301-1201
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Country | US
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Telephone | 503-851-5518
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRYCE LISSER
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Credential | LAC
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Telephone | 503-830-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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