Provider Demographics
NPI:1164292587
Name:EMPOWER MIND & BODY LLC
Entity Type:Organization
Organization Name:EMPOWER MIND & BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MUQTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-895-5976
Mailing Address - Street 1:4130 SW 117TH AVE # A165
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-5606
Mailing Address - Country:US
Mailing Address - Phone:971-895-5976
Mailing Address - Fax:
Practice Address - Street 1:4130 SW 117TH AVE # A165
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-5606
Practice Address - Country:US
Practice Address - Phone:971-895-5976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)