Provider Demographics
NPI:1811714744
Name:THE EMBODIED WELLNESS STUDIO LLC
Entity type:Organization
Organization Name:THE EMBODIED WELLNESS STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARATTA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-308-9593
Mailing Address - Street 1:9445 SW MOUNTAIN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-5942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11850 SW 67TH AVE STE 145
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8961
Practice Address - Country:US
Practice Address - Phone:503-308-9593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty