Provider Demographics
NPI:1720546658
Name:ANATRYPSIS MASSAGE AND WELLNESS
Entity Type:Organization
Organization Name:ANATRYPSIS MASSAGE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-816-4332
Mailing Address - Street 1:4479 S PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-6600
Mailing Address - Country:US
Mailing Address - Phone:541-210-0226
Mailing Address - Fax:
Practice Address - Street 1:711 E MAIN ST STE 16
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7139
Practice Address - Country:US
Practice Address - Phone:541-816-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TROIS ESTHETICS AND MASSAGE LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR21801OtherLMT NUMBER