Provider Demographics
NPI:1881009710
Name:BODY OF WORK WELLNESS
Entity Type:Organization
Organization Name:BODY OF WORK WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-290-6636
Mailing Address - Street 1:3220 NW 185TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3492
Mailing Address - Country:US
Mailing Address - Phone:503-290-6636
Mailing Address - Fax:503-213-7100
Practice Address - Street 1:3220 NW 185TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-3492
Practice Address - Country:US
Practice Address - Phone:503-290-6636
Practice Address - Fax:503-213-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty