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General NPI Number Information
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NPI Number | 1366826471
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Entity Type | Organization
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Legal Business Name | BODY MECHANIX
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 6446 NW LYNCH LN
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City | REDMOND
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State | OR
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Zip | 97756-8181
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Country | US
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Telephone | 541-610-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 850 SW 7TH ST
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City | REDMOND
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State | OR
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Zip | 97756-2760
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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 | LMT
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Name | LETICIA ROMAN
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Credential |
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Telephone | 541-610-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 17244
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License Number State | OR
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