Provider Demographics
NPI:1659654424
Name:A TOUCH OF TRANQUILITY MASSAGE
Entity Type:Organization
Organization Name:A TOUCH OF TRANQUILITY MASSAGE
Other - Org Name:ATHENA ROLPH LMT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:WRENNETTE
Authorized Official - Last Name:ROLPH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:971-409-0949
Mailing Address - Street 1:11943 SE 362ND AVE
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-8720
Mailing Address - Country:US
Mailing Address - Phone:971-409-0949
Mailing Address - Fax:503-663-0664
Practice Address - Street 1:17150 UNIVERSITY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-9290
Practice Address - Country:US
Practice Address - Phone:971-409-0949
Practice Address - Fax:503-663-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18063261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service