Provider Demographics
NPI:1669880621
Name:HERB GYPSY MASSAGE
Entity type:Organization
Organization Name:HERB GYPSY MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:CHELLE
Authorized Official - Last Name:APATHY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-903-1288
Mailing Address - Street 1:PO BOX 1841
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1841
Mailing Address - Country:US
Mailing Address - Phone:541-903-1288
Mailing Address - Fax:
Practice Address - Street 1:1470 NE 1ST ST STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4217
Practice Address - Country:US
Practice Address - Phone:541-903-1288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty