Provider Demographics
NPI:1215292230
Name:SIX ELEMENTS BODYWORK, LLC
Entity type:Organization
Organization Name:SIX ELEMENTS BODYWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-281-4866
Mailing Address - Street 1:22400 SE STARK ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2656
Mailing Address - Country:US
Mailing Address - Phone:503-281-4866
Mailing Address - Fax:503-907-0098
Practice Address - Street 1:22400 SE STARK ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2656
Practice Address - Country:US
Practice Address - Phone:503-281-4866
Practice Address - Fax:503-907-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11624225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1487846127OtherNPI TYPE 1