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General NPI Number Information
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NPI Number | 1922482249
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Entity Type | Organization
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Legal Business Name | REST, RELAX, RECOVER THERAPEUTIC MASSAGE CENTER
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1834 MCPHERSON ST SUITE B
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City | NORTH BEND
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State | OR
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Zip | 97459-3414
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Country | US
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Telephone | 541-751-9990
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Fax | 541-808-0887
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Provider Business Mailing Address
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Address Line | PO BOX 1559
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City | NORTH BEND
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State | OR
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Zip | 97459-0090
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Country | US
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Telephone | 541-751-9990
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Fax | 541-808-0887
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Authorized Official
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Title or Position | OWNER
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Name | MARIA E FORTY
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Credential | LMT
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Telephone | 541-751-9990
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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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