# ASHLAND MYOFASCIAL RELEASE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033882972
- **Authorized official:** MICHAEL SERVANT MPT (LLC MEMBER)
- **Authorized official phone:** (541) 261-4751

## Contact information

- **Practice address:** 308 N LAUREL ST, ASHLAND, OR 97520-1111
- **Practice address phone:** (541) 482-9182
- **Practice address fax:** (541) 482-9181
- **Mailing address:** 308 N LAUREL ST, ASHLAND, OR 97520-1111
- **Mailing address phone:** (541) 482-9182
- **Mailing address fax:** (541) 482-9181

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/27/2021
- **Last updated:** 07/27/2021