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Organization
PERFORMANCE BODYWORK LLC
Active
Organization
PERFORMANCE BODYWORK LLC
Active
Other names
Surge Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY HOLLIMAN LMT (PRESIDENT)
(503) 568-1390
Entity
Organization
Contact information
Practice address
2188 SW PARK PL, SUITE 10, PORTLAND, OR 97205-1100
(503) 568-1390
Mailing address
2188 SW PARK PL, SUITE 10, PORTLAND, OR 97205-1100
(503) 568-1390
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
171100000X
Acupuncturist
—
—
225700000X
Massage Therapist
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
07/01/2014
Last updated
07/25/2024
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