Provider Demographics
NPI:1265094528
Name:EVEXIA, LLC
Entity type:Organization
Organization Name:EVEXIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DRAKULICH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-482-2122
Mailing Address - Street 1:9123 SE SAINT HELENS ST # 1001A
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6858
Mailing Address - Country:US
Mailing Address - Phone:503-482-2122
Mailing Address - Fax:
Practice Address - Street 1:9123 SE SAINT HELENS ST STE 100A
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6800
Practice Address - Country:US
Practice Address - Phone:503-482-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-07
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty