Provider Demographics
NPI:1972009397
Name:ROSA'S HEALING TOUCH MASSAGE
Entity Type:Organization
Organization Name:ROSA'S HEALING TOUCH MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/L.M.T.
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSAMABELLE 'ROSA'
Authorized Official - Middle Name:BACON
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MASSAGE THE
Authorized Official - Phone:541-968-9278
Mailing Address - Street 1:PO BOX 10861
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-2861
Mailing Address - Country:US
Mailing Address - Phone:541-968-9278
Mailing Address - Fax:541-431-7089
Practice Address - Street 1:63 N MADISON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5015
Practice Address - Country:US
Practice Address - Phone:541-968-9278
Practice Address - Fax:541-431-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty