Provider Demographics
NPI:1689456857
Name:LET GO IN THE COUNTRY MASSAGE
Entity Type:Organization
Organization Name:LET GO IN THE COUNTRY MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:503-481-6079
Mailing Address - Street 1:14520 NW SELLERS RD
Mailing Address - Street 2:
Mailing Address - City:BANKS
Mailing Address - State:OR
Mailing Address - Zip Code:97106-7102
Mailing Address - Country:US
Mailing Address - Phone:150-348-1607
Mailing Address - Fax:
Practice Address - Street 1:41745 NW WILKESBORO RD
Practice Address - Street 2:
Practice Address - City:BANKS
Practice Address - State:OR
Practice Address - Zip Code:97106-8114
Practice Address - Country:US
Practice Address - Phone:503-481-6079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty