Provider Demographics
NPI:1982907267
Name:ADVANCED BODYWORK AND MASSAGE LLC
Entity type:Organization
Organization Name:ADVANCED BODYWORK AND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-883-9375
Mailing Address - Street 1:1018 NE 3RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4403
Mailing Address - Country:US
Mailing Address - Phone:503-883-9375
Mailing Address - Fax:
Practice Address - Street 1:1018 NE 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4403
Practice Address - Country:US
Practice Address - Phone:503-883-9375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty