Provider Demographics
NPI:1689906794
Name:HEALING TREE MASSAGE AND BODYWORK, LLC
Entity type:Organization
Organization Name:HEALING TREE MASSAGE AND BODYWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-929-7599
Mailing Address - Street 1:4811 SE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4653
Mailing Address - Country:US
Mailing Address - Phone:503-929-7599
Mailing Address - Fax:
Practice Address - Street 1:1016 SE 12TH AVE
Practice Address - Street 2:#9
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2513
Practice Address - Country:US
Practice Address - Phone:503-929-7599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty