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General NPI Number Information
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NPI Number | 1740524735
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Entity Type | Organization
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Legal Business Name | BIO FOOT REFLEXOLOGY AND MASSAGE CENTER, LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 3805 SW HALL BLVD
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City | BEAVERTON
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State | OR
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Zip | 97005-2049
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Country | US
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Telephone | 503-526-9285
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Fax |
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Provider Business Mailing Address
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Address Line | 3805 SW HALL BLVD
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City | BEAVERTON
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State | OR
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Zip | 97005-2049
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Country | US
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Telephone | 503-526-9285
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Fax |
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | MR. MICHAEL ALDEN LEARD
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Credential |
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Telephone | 503-526-9285
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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 | 18829
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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 | 17234
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License Number State | OR
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