Provider Demographics
NPI:1538673306
Name:ZETTZ MASSAGE
Entity Type:Organization
Organization Name:ZETTZ MASSAGE
Other - Org Name:ZETTZ MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAZETTE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HARNISH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-750-2219
Mailing Address - Street 1:6125 NE CORNELL RD STE 390
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5417
Mailing Address - Country:US
Mailing Address - Phone:503-530-8517
Mailing Address - Fax:
Practice Address - Street 1:6125 NE CORNELL RD STE 390
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5417
Practice Address - Country:US
Practice Address - Phone:503-530-8517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11063225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty