Provider Demographics
NPI:1962849489
Name:THE BRIGHT WAY MASSAGE THERAPY, LLC
Entity Type:Organization
Organization Name:THE BRIGHT WAY MASSAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKING
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-407-8246
Mailing Address - Street 1:1020 SW TAYLOR ST
Mailing Address - Street 2:SUITE 645
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2543
Mailing Address - Country:US
Mailing Address - Phone:503-407-8246
Mailing Address - Fax:888-208-6024
Practice Address - Street 1:1020 SW TAYLOR ST
Practice Address - Street 2:SUITE 645
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2543
Practice Address - Country:US
Practice Address - Phone:503-407-8246
Practice Address - Fax:888-208-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1538280037OtherNPI TYPE I