Provider Demographics
NPI:1528427887
Name:RESTORATIVE WELLNESS
Entity type:Organization
Organization Name:RESTORATIVE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-892-0191
Mailing Address - Street 1:11155 SW HALL BLVD
Mailing Address - Street 2:APT 99
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8464
Mailing Address - Country:US
Mailing Address - Phone:541-892-0191
Mailing Address - Fax:
Practice Address - Street 1:419 NW 23RD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3470
Practice Address - Country:US
Practice Address - Phone:541-892-0191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty