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General NPI Number Information
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NPI Number | 1760921837
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Entity Type | Organization
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Legal Business Name | BODY OF LIFE MASSAGE
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 3800 SW CEDAR HILLS BLVD SUITE 193
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City | BEAVERTON
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State | OR
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Zip | 97005-2027
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Country | US
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Telephone | 541-954-9979
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 SW CEDAR HILLS BLVD SUITE 193
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City | BEAVERTON
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State | OR
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Zip | 97005-2027
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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
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Name | JESSICA FISHER
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Credential | LMT
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Telephone | 541-954-9979
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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 | 22736
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License Number State | OR
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