Provider Demographics
NPI:1922866979
Name:KNEADED BALANCE LLC
Entity Type:Organization
Organization Name:KNEADED BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:504-939-6922
Mailing Address - Street 1:8965 SW 157TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6674
Mailing Address - Country:US
Mailing Address - Phone:503-939-6922
Mailing Address - Fax:503-371-7974
Practice Address - Street 1:8029 SW CIRRUS DR BLDG 21
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5983
Practice Address - Country:US
Practice Address - Phone:503-939-6922
Practice Address - Fax:503-371-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty