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General NPI Number Information
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NPI Number | 1972830149
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Entity Type | Organization
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Legal Business Name | SISKIYOU MASSAGE, LLC
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 550 SISKIYOU BLVD.
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City | ASHLAND
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State | OR
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Zip | 97520
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Country | US
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Telephone | 541-488-6757
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Fax | 541-482-2064
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Provider Business Mailing Address
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Address Line | 550 SISKIYOU BLVD
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City | ASHLAND
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State | OR
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Zip | 97520
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Country | US
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Telephone | 541-488-6757
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Fax | 541-482-2064
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Authorized Official
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Title or Position | OWNER
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Name | MR. PHILIP WHITMORE
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Credential | LMT
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Telephone | 541-488-6757
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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 | 11678
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License Number State | OR
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