Provider Demographics
NPI:1265060966
Name:BEAVERTON MASSAGE STUDIO
Entity type:Organization
Organization Name:BEAVERTON MASSAGE STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:CORRIN
Authorized Official - Last Name:LAWVOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-332-4347
Mailing Address - Street 1:14631 SW MILLIKAN WAY STE 11
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2999
Mailing Address - Country:US
Mailing Address - Phone:503-754-7949
Mailing Address - Fax:503-662-6115
Practice Address - Street 1:14631 SW MILLIKAN WAY STE 11
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-2999
Practice Address - Country:US
Practice Address - Phone:503-754-7949
Practice Address - Fax:503-662-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty