Provider Demographics
NPI:1235590647
Name:GEMINI THERAPEUTICS
Entity Type:Organization
Organization Name:GEMINI THERAPEUTICS
Other - Org Name:ARBOR VITAE BODYWORK LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:340-998-1961
Mailing Address - Street 1:PO BOX 6507
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6507
Mailing Address - Country:US
Mailing Address - Phone:340-998-1961
Mailing Address - Fax:
Practice Address - Street 1:61277 SPLENDOR LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2974
Practice Address - Country:US
Practice Address - Phone:340-998-1961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19743174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty