Provider Demographics
NPI:1760760532
Name:MEDICAL MASSAGE N.W. L.L.C
Entity Type:Organization
Organization Name:MEDICAL MASSAGE N.W. L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-516-5354
Mailing Address - Street 1:8655 SW CITIZENS DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7475
Mailing Address - Country:US
Mailing Address - Phone:503-516-5354
Mailing Address - Fax:
Practice Address - Street 1:8655 SW CITIZENS DR
Practice Address - Street 2:SUITE 206
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7475
Practice Address - Country:US
Practice Address - Phone:503-516-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty