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General NPI Number Information
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NPI Number | 1932861325
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Entity Type | Organization
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Legal Business Name | STUDIO 15 MASSAGE THERAPY
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 14631 SW MILLIKAN WAY STE 15
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City | BEAVERTON
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State | OR
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Zip | 97003-2999
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Country | US
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Telephone | 971-777-5650
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Fax | 503-747-7788
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Provider Business Mailing Address
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Address Line | 9273 N OSWEGO AVE
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City | PORTLAND
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State | OR
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Zip | 97203-2336
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Country | US
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Telephone | 971-777-5650
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DONNA JULIA LANGFORD
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Credential | LMT 14368
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Telephone | 971-777-5650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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