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General NPI Number Information
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NPI Number | 1336658871
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Entity Type | Organization
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Legal Business Name | MASSAGE ONE, LLC
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 3795 RIVER RD N SUITE D
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City | KEIZER
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State | OR
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Zip | 97303
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Country | US
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Telephone | 971-301-8677
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Fax |
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Provider Business Mailing Address
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Address Line | 3795 RIVER RD N SUITE D
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City | KEIZER
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State | OR
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Zip | 97303
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Country | US
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Telephone | 971-301-8677
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Fax |
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Authorized Official
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Title or Position | LMT/OWNER
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Name | MR. AARON FIELDS
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Credential | LMT
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Telephone | 971-301-8677
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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 | 023177
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License Number State | OR
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