Provider Demographics
NPI:1043099484
Name:ADVANCED MASSAGE LLC
Entity Type:Organization
Organization Name:ADVANCED MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWINE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-261-3384
Mailing Address - Street 1:1986 SKYPARK DR APT D
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5759
Mailing Address - Country:US
Mailing Address - Phone:541-261-3384
Mailing Address - Fax:
Practice Address - Street 1:7 CRATER LAKE AVE STE G
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7466
Practice Address - Country:US
Practice Address - Phone:541-261-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty