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General NPI Number Information
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NPI Number | 1801778972
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Entity Type | Organization
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Legal Business Name | BITTERROOT BODYWORK LLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 20261 KNIGHTSBRIDGE PL
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City | BEND
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State | OR
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Zip | 97702-3534
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Country | US
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Telephone | 541-306-7873
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Fax |
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Provider Business Mailing Address
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Address Line | 20261 KNIGHTSBRIDGE PL
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City | BEND
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State | OR
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Zip | 97702-3534
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Country | US
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Telephone | 541-306-7873
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JESSE MAE ABRAHAM
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Credential | LMT
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Telephone | 541-306-7873
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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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