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General NPI Number Information
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NPI Number | 1932673878
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Entity Type | Organization
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Legal Business Name | EASTERN FLOW MASSAGE
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 764 S 2ND ST
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City | LEBANON
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State | OR
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Zip | 97355-3244
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Country | US
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Telephone | 541-286-5215
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Fax | 844-341-9622
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Provider Business Mailing Address
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Address Line | 764 S 2ND ST
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City | LEBANON
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State | OR
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Zip | 97355-3244
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Country | US
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Telephone | 541-286-5215
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Fax | 844-341-9622
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SARA JEAN MCELDOWNEY
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Credential | LMT
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Telephone | 218-340-8963
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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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