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General NPI Number Information
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NPI Number | 1821565144
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Entity Type | Organization
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Legal Business Name | MABODYWORK, LLC
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 7911 SE STARK ST STE B
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City | PORTLAND
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State | OR
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Zip | 97215-2341
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Country | US
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Telephone | 503-345-5195
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Fax |
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Provider Business Mailing Address
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Address Line | 7911 SE STARK ST STE B
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City | PORTLAND
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State | OR
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Zip | 97215-2341
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Country | US
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Telephone | 503-345-5195
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | MEAGEN M ALM-LUNAN
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Credential | LMT
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Telephone | 503-345-5195
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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 |
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License Number State |
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