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General NPI Number Information
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NPI Number | 1245851799
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Entity Type | Organization
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Legal Business Name | SUNRISE HEALING ARTS LLC
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 1845 HIGHWAY 126 STE A
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City | FLORENCE
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State | OR
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Zip | 97439-9626
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Country | US
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Telephone | 425-891-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 625 HWY 101 PMB 329
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City | FLORENCE
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State | OR
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Zip | 97439
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Country | US
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Telephone | 425-891-0332
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | COREY IONE BURGESS
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Credential |
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Telephone | 426-891-0332
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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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