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General NPI Number Information
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NPI Number | 1528427887
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Entity Type | Organization
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Legal Business Name | RESTORATIVE WELLNESS
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 419 NW 23RD AVE SUITE 101
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City | PORTLAND
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State | OR
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Zip | 97210-3470
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Country | US
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Telephone | 541-892-0191
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Fax |
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Provider Business Mailing Address
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Address Line | 11155 SW HALL BLVD APT 99
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City | TIGARD
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State | OR
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Zip | 97223-8464
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Country | US
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Telephone | 541-892-0191
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TASHA A FLOWERS
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Credential | LMT
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Telephone | 541-892-0191
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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 | 20933
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License Number State | OR
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