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General NPI Number Information
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NPI Number | 1538005293
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Entity Type | Organization
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Legal Business Name | LONGEVITY LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 2863 JEROME PRAIRIE RD
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City | GRANTS PASS
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State | OR
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Zip | 97527-9156
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Country | US
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Telephone | 541-660-2791
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 653
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City | MURPHY
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State | OR
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Zip | 97533-0653
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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 | ASHLEY PHAIGH
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Credential | LMT
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Telephone | 541-660-2791
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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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