Provider Demographics
NPI:1942865167
Name:PURE MASSAGE & SPA LLC
Entity Type:Organization
Organization Name:PURE MASSAGE & SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YISHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-990-7570
Mailing Address - Street 1:4155 RICKEY ST SE STE 122
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-6903
Mailing Address - Country:US
Mailing Address - Phone:503-990-7570
Mailing Address - Fax:
Practice Address - Street 1:4155 RICKEY ST SE STE 122
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-6903
Practice Address - Country:US
Practice Address - Phone:503-990-7570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty