MEDICARE: WELL BEING MASSAGE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	11343	OR

General Provider Information

NPI Number	:	1225362791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELL BEING MASSAGE, LLC

Provider Business Mailing Address
First Line	:	2304 E BURNSIDE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1677
Country	:	US
Telephone Number	:	503-753-5910
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 E BURNSIDE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1677
Country	:	US
Telephone Number	:	503-753-5910
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY ANN RAY
Credential	:	LMT
Telephone Number	:	503-753-5910

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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