Provider Demographics
NPI:1528329513
Name:WELLSPRING MASSAGE LLC
Entity type:Organization
Organization Name:WELLSPRING MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-653-5325
Mailing Address - Street 1:10600 SE MCLOUGHLIN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7428
Mailing Address - Country:US
Mailing Address - Phone:503-653-5325
Mailing Address - Fax:503-653-5328
Practice Address - Street 1:10600 SE MCLOUGHLIN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7428
Practice Address - Country:US
Practice Address - Phone:503-653-5325
Practice Address - Fax:503-653-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty