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General NPI Number Information
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NPI Number | 1447107412
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Entity Type | Organization
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Legal Business Name | SOLACE WELLNESS LLC
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 1016 SE 12TH AVE OFC 7
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City | PORTLAND
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State | OR
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Zip | 97214-2513
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Country | US
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Telephone | 509-531-3449
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Fax |
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Provider Business Mailing Address
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Address Line | 3721 SE 13TH AVE APT 3
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City | PORTLAND
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State | OR
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Zip | 97202-3863
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Country | US
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Telephone | 509-531-3449
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KERSEY D FITZPATRICK
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Credential | LMT 29571
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Telephone | 509-531-3449
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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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