Provider Demographics
NPI:1790020196
Name:RANDEE ANSHUTZ NUTRITION AND MASSAGE THERAPY
Entity Type:Organization
Organization Name:RANDEE ANSHUTZ NUTRITION AND MASSAGE THERAPY
Other - Org Name:SYNERGY HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSHUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, NCTMB
Authorized Official - Phone:541-323-3488
Mailing Address - Street 1:244 NE FRANKLIN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4959
Mailing Address - Country:US
Mailing Address - Phone:541-323-3488
Mailing Address - Fax:541-323-3483
Practice Address - Street 1:244 NE FRANKLIN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4959
Practice Address - Country:US
Practice Address - Phone:541-323-3488
Practice Address - Fax:541-323-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7602261QH0100X
OR1024261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service