Provider Demographics
NPI:1932497047
Name:AVALON HOLISTIC THERAPIES, LLC
Entity Type:Organization
Organization Name:AVALON HOLISTIC THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANN-MARIE
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:HALL-POND
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-544-2463
Mailing Address - Street 1:2945 SE 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-6223
Mailing Address - Country:US
Mailing Address - Phone:503-544-2463
Mailing Address - Fax:360-828-7866
Practice Address - Street 1:2927 SE 73RD AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-6223
Practice Address - Country:US
Practice Address - Phone:503-640-7722
Practice Address - Fax:503-649-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17372172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty