Provider Demographics
NPI:1366861411
Name:TRUE NORTH MASSAGE LLC
Entity Type:Organization
Organization Name:TRUE NORTH MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:RESARI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-880-7977
Mailing Address - Street 1:5517 N COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2339
Mailing Address - Country:US
Mailing Address - Phone:503-880-7977
Mailing Address - Fax:
Practice Address - Street 1:5517 N COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2339
Practice Address - Country:US
Practice Address - Phone:503-880-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12784225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty