Provider Demographics
NPI:1154984060
Name:WARRIOR WITHIN WELLNESS LLC
Entity type:Organization
Organization Name:WARRIOR WITHIN WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-482-4499
Mailing Address - Street 1:3863 SW HALL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2042
Mailing Address - Country:US
Mailing Address - Phone:503-482-4499
Mailing Address - Fax:503-214-8790
Practice Address - Street 1:3863 SW HALL BLVD STE B
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2042
Practice Address - Country:US
Practice Address - Phone:503-482-4499
Practice Address - Fax:503-214-8790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty