Provider Demographics
NPI:1831641232
Name:BODY AWARE MASSAGE
Entity Type:Organization
Organization Name:BODY AWARE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNLIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-473-4513
Mailing Address - Street 1:2225 NE ALBERTA ST STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5886
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2225 NE ALBERTA ST STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5886
Practice Address - Country:US
Practice Address - Phone:503-473-4513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6628225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty