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General NPI Number Information
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NPI Number | 1699195073
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Entity Type | Organization
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Legal Business Name | ELK ROCK WELLNESS
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 2403 SE MONROE ST STE B
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City | MILWAUKIE
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State | OR
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Zip | 97222-7646
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Country | US
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Telephone | 503-303-4078
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Fax |
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Provider Business Mailing Address
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Address Line | 2403 SE MONROE ST STE B
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City | MILWAUKIE
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State | OR
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Zip | 97222-7646
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Country | US
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Telephone | 503-303-4078
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESLEY SARIO
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Credential | LMT
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Telephone | 503-303-4078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 12973
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 12973
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License Number State | OR
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