Provider Demographics
NPI:1962392068
Name:BLUE WELLNESS STUDIO, LLC
Entity type:Organization
Organization Name:BLUE WELLNESS STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-801-6939
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:PACIFIC CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97135-0061
Mailing Address - Country:US
Mailing Address - Phone:503-801-6939
Mailing Address - Fax:
Practice Address - Street 1:35170 BROOTEN RD STE B
Practice Address - Street 2:
Practice Address - City:PACIFIC CITY
Practice Address - State:OR
Practice Address - Zip Code:97135-8036
Practice Address - Country:US
Practice Address - Phone:503-801-6939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-09
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty