Provider Demographics
NPI:1407519192
Name:POWERFULL TOUCH BODY WORK
Entity Type:Organization
Organization Name:POWERFULL TOUCH BODY WORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGEI
Authorized Official - Middle Name:SERGEEVICH
Authorized Official - Last Name:KRAVCHENKO
Authorized Official - Suffix:SR
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-810-6436
Mailing Address - Street 1:13301 SW CLEARVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-810-6436
Mailing Address - Fax:503-419-6200
Practice Address - Street 1:10001 SE SUNNYSIDE RD.
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-810-6436
Practice Address - Fax:503-419-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty