Provider Demographics
NPI:1083393011
Name:ERIN RENE BODYWORK AND COACHING, LLC
Entity Type:Organization
Organization Name:ERIN RENE BODYWORK AND COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:SUDDUTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-678-9513
Mailing Address - Street 1:1025 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-4001
Mailing Address - Country:US
Mailing Address - Phone:503-678-9513
Mailing Address - Fax:888-538-0460
Practice Address - Street 1:1025 2ND ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4001
Practice Address - Country:US
Practice Address - Phone:503-678-9513
Practice Address - Fax:888-538-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty