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Organization
URBAN MASSAGE LLC
Active
Organization
URBAN MASSAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAREN NACOSTE LMT (MANAGER)
(503) 784-3514
Entity
Organization
Contact information
Practice address
13043 SE 84TH AVE, CLACKAMAS, OR 97015-9798
(503) 784-3514
Mailing address
PO BOX 90543, PORTLAND, OR 97290-0543
(503) 307-0299
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326320433
—
OR
Enumeration date
05/26/2020
Last updated
05/26/2020
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