Provider Demographics
NPI:1316603475
Name:CRESWELL WELLNESS CENTER
Entity Type:Organization
Organization Name:CRESWELL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PISANI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-895-4464
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-0758
Mailing Address - Country:US
Mailing Address - Phone:541-895-4464
Mailing Address - Fax:541-895-3359
Practice Address - Street 1:24 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9259
Practice Address - Country:US
Practice Address - Phone:541-895-4464
Practice Address - Fax:541-895-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty