# BODY ESSENTIAL PHYSICAL THERAPY AND MASSAGE, LLC

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

## Provider details

- **NPI number:** 1396130894
- **Authorized official:** JENNIFER HAWKS (SOLE PROPRIETOR OWNER AND STAFF)
- **Authorized official phone:** (541) 784-7771

## Contact information

- **Practice address:** 1032 SE LANE AVE, ROSEBURG, OR 97470-3956
- **Practice address phone:** (541) 784-7771
- **Practice address fax:** (541) 672-1466
- **Mailing address:** 428 OAKVIEW DR, ROSEBURG, OR 97471-9519

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 03533 | OR | Yes |
| 225700000X | Massage Therapist | 13630 | OR | — |

## Other

- **Enumeration date:** 04/01/2015
- **Last updated:** 05/24/2023