Provider Demographics
NPI:1356155113
Name:BROOKS' WELLNESS MASSAGE LLC
Entity type:Organization
Organization Name:BROOKS' WELLNESS MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-562-0654
Mailing Address - Street 1:806 IKE MOONEY RD NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-8707
Mailing Address - Country:US
Mailing Address - Phone:503-562-0654
Mailing Address - Fax:
Practice Address - Street 1:806 IKE MOONEY RD NE
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-8707
Practice Address - Country:US
Practice Address - Phone:503-562-0654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty