Provider Demographics
NPI:1629723572
Name:NEW ROOTS MASSAGE
Entity Type:Organization
Organization Name:NEW ROOTS MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:208-860-6001
Mailing Address - Street 1:650 MARION ST NE APT 4A
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3750
Mailing Address - Country:US
Mailing Address - Phone:208-860-6001
Mailing Address - Fax:
Practice Address - Street 1:223 COMMERCIAL ST NE STE 109
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3411
Practice Address - Country:US
Practice Address - Phone:971-290-4376
Practice Address - Fax:971-275-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty