Provider Demographics
NPI:1932673878
Name:EASTERN FLOW MASSAGE
Entity Type:Organization
Organization Name:EASTERN FLOW MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MCELDOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:218-340-8963
Mailing Address - Street 1:764 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-3244
Mailing Address - Country:US
Mailing Address - Phone:541-286-5215
Mailing Address - Fax:844-341-9622
Practice Address - Street 1:764 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3244
Practice Address - Country:US
Practice Address - Phone:541-286-5215
Practice Address - Fax:844-341-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1780834200OtherNPI
OR1174066864OtherNPI