Provider Demographics
NPI:1700453735
Name:ESSENTIAL YOGA AND MASSAGE LLC
Entity Type:Organization
Organization Name:ESSENTIAL YOGA AND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-729-1731
Mailing Address - Street 1:120 SHELTON MCMURPHEY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8718
Mailing Address - Country:US
Mailing Address - Phone:541-799-7055
Mailing Address - Fax:
Practice Address - Street 1:120 SHELTON MCMURPHEY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8718
Practice Address - Country:US
Practice Address - Phone:541-799-7055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty