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General NPI Number Information
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NPI Number | 1245771369
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Entity Type | Organization
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Legal Business Name | BODY & FACE LLC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 15455 NW GREENBRIER PKWY SUITE 120
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City | BEAVERTON
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State | OR
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Zip | 97006-7374
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Country | US
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Telephone | 503-888-5082
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Fax | 971-256-9922
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Provider Business Mailing Address
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Address Line | 2373 NW 185TH AVE 1001
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City | HILLSBORO
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State | OR
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Zip | 97124-7076
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Country | US
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Telephone | 503-888-5082
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Fax | 971-256-9922
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Authorized Official
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Title or Position | OWNER, AGENT
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Name | MR. ALEXANDER ZAWADZKI
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Credential | LMT
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Telephone | 503-888-5082
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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 | 13354
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License Number State | OR
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