Provider Demographics
NPI:1124167226
Name:MASSAGE THERAPY CENTER OF SANDY
Entity type:Organization
Organization Name:MASSAGE THERAPY CENTER OF SANDY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-826-0141
Mailing Address - Street 1:38971 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8080
Mailing Address - Country:US
Mailing Address - Phone:503-826-0141
Mailing Address - Fax:
Practice Address - Street 1:38971 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8080
Practice Address - Country:US
Practice Address - Phone:503-826-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11803225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty