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Organization
WILD MOSS WELLNESS LLC
Active
Organization
WILD MOSS WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIYA TENNEY (OWNER)
(507) 676-3180
Entity
Organization
Contact information
Practice address
529 SE GRAND AVE STE 300D, PORTLAND, OR 97214-2232
(503) 410-3013
Mailing address
529 SE GRAND AVE STE 300D, PORTLAND, OR 97214-2232
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
03/27/2024
Last updated
03/27/2024
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