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General NPI Number Information
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NPI Number | 1548823305
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Entity Type | Organization
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Legal Business Name | GORGE BODY THERAPY
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1216 C ST
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City | HOOD RIVER
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State | OR
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Zip | 97031-1698
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Country | US
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Telephone | 541-241-6350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 314
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City | MOUNT HOOD PARKDALE
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State | OR
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Zip | 97041-0314
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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 | REBECC PARKER
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Credential | LMT
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Telephone | 707-953-7449
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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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