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General NPI Number Information
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NPI Number | 1457692790
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Entity Type | Organization
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Legal Business Name | ENHANCING HEALTH MASSAGE, LLC
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 6519 SE MILWAUKIE AVE SUITE #203
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City | PORTLAND
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State | OR
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Zip | 97202-5519
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Country | US
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Telephone | 503-515-1252
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Fax |
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Provider Business Mailing Address
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Address Line | 6519 SE MILWAUKIE AVE SUITE #203
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City | PORTLAND
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State | OR
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Zip | 97202-5519
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Country | US
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Telephone | 503-515-1252
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Fax |
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Authorized Official
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Title or Position | LMT
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Name | MRS. BRANDY LYNN GAYOMALI
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Credential |
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Telephone | 503-515-1252
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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 | 15787
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License Number State | OR
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