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General NPI Number Information
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NPI Number | 1720764756
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Entity Type | Organization
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Legal Business Name | HEART FLOW MASSAGE LLC
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 147 COMMERCIAL ST NE
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City | SALEM
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State | OR
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Zip | 97301-3416
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Country | US
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Telephone | 971-217-8370
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Fax |
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Provider Business Mailing Address
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Address Line | 1916 MEADOWLARK DR NE
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City | KEIZER
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State | OR
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Zip | 97303-1955
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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, PROVIDER
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Name | GENEVIEVE DAUGHERTY
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Credential | LMT, CMLDT
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Telephone | 917-597-5829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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