Provider Demographics
NPI:1881064038
Name:INFINITE ENERGY BODYWORK
Entity type:Organization
Organization Name:INFINITE ENERGY BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:V
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-219-2781
Mailing Address - Street 1:1970 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2300
Mailing Address - Country:US
Mailing Address - Phone:541-219-2781
Mailing Address - Fax:
Practice Address - Street 1:1970 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2300
Practice Address - Country:US
Practice Address - Phone:541-219-2781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty