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General NPI Number Information
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NPI Number | 1437555034
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Entity Type | Organization
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Legal Business Name | RUNNER'S THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 11/08/2014
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Last Update Date | 11/08/2014
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Provider Practice Location Address
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Address Line | 3860 RIVER RD N
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City | KEIZER
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State | OR
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Zip | 97303-4886
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Country | US
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Telephone | 503-395-0125
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 FIRCREST CT SE
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City | SALEM
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State | OR
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Zip | 97306-1336
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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 | OWNER
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Name | LACEY RUNNER
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Credential | LMT
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Telephone | 503-395-0125
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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 | 20959
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License Number State | OR
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