Provider Demographics
NPI: | 1598062242 |
---|---|
Name: | CARCON |
Entity Type: | Organization |
Organization Name: | CARCON |
Other - Org Name: | MASSAGE ENVY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | STEVE |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | NORRIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 503-625-0100 |
Mailing Address - Street 1: | 16078 SW TUALATIN SHERWOOD RD |
Mailing Address - Street 2: | |
Mailing Address - City: | SHERWOOD |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97140-8522 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-625-0100 |
Mailing Address - Fax: | 503-625-0301 |
Practice Address - Street 1: | 16078 SW TUALATIN SHERWOOD RD |
Practice Address - Street 2: | |
Practice Address - City: | SHERWOOD |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97140-8522 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-625-0100 |
Practice Address - Fax: | 503-625-0301 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-02-15 |
Last Update Date: | 2011-02-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty |