Organization
REPARE MASSAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE JUNE CHRISTIANSEN LMT (OWNER/PROVIDER)
(503) 679-6881
Entity
Organization
Contact information
Practice address
4004 SW KELLY AVE STE 203, PORTLAND, OR 97239-4389
(503) 679-6881
Mailing address
4004 SW KELLY AVE STE 203, PORTLAND, OR 97239-4389
(503) 679-6881
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
8052
OR
302R00000X
Health Maintenance Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
542966745
SS
—
Enumeration date
06/07/2017
Last updated
07/21/2022
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