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General NPI Number Information
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NPI Number | 1629723572
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Entity Type | Organization
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Legal Business Name | NEW ROOTS MASSAGE
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 223 COMMERCIAL ST NE STE 109
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City | SALEM
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State | OR
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Zip | 97301-3411
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Country | US
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Telephone | 971-290-4376
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Fax | 971-275-1900
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Provider Business Mailing Address
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Address Line | 650 MARION ST NE APT 4A
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City | SALEM
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State | OR
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Zip | 97301-3750
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Country | US
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Telephone | 208-860-6001
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | KYLEE VEERKAMP
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Credential | LMT
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Telephone | 208-860-6001
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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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