Provider Demographics
NPI:1023241064
Name:FOOTLOOSE MASSAGE THERAPY INC
Entity type:Organization
Organization Name:FOOTLOOSE MASSAGE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-686-4461
Mailing Address - Street 1:35 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2901
Mailing Address - Country:US
Mailing Address - Phone:541-686-4461
Mailing Address - Fax:541-686-4465
Practice Address - Street 1:35 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2901
Practice Address - Country:US
Practice Address - Phone:541-686-4461
Practice Address - Fax:541-686-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty