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General NPI Number Information
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NPI Number | 1558726273
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Entity Type | Organization
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Legal Business Name | SHIFTING SANDS HOLISTIC HEALING LLC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 328 W MAIN ST STE A100
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City | HILLSBORO
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State | OR
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Zip | 97123-3985
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Country | US
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Telephone | 503-882-8081
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Fax |
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Provider Business Mailing Address
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Address Line | 1271 SE LEANDER ST
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City | HILLSBORO
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State | OR
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Zip | 97123-5199
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Country | US
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Telephone | 503-882-8081
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MARIA A MONTERA
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Credential | LMT
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Telephone | 503-882-8081
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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 | 8313
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License Number State | OR
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