Provider Demographics
NPI:1922491315
Name:BALANCED CARE MASSAGE
Entity Type:Organization
Organization Name:BALANCED CARE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYCIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-969-7430
Mailing Address - Street 1:6954 N GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5236
Mailing Address - Country:US
Mailing Address - Phone:503-969-7430
Mailing Address - Fax:
Practice Address - Street 1:6954 N GREELEY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5236
Practice Address - Country:US
Practice Address - Phone:503-969-7430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty