Organization
BLOOMING MOON WELLNESS SPA INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINNY L TOUSIGNANT ESTHETICIAN COS-FT (OWNER AND ESTHETICIAN)
(971) 279-2757
Entity
Organization
Contact information
Practice address
1920 N KILLINGSWORTH ST, PORTLAND, OR 97217-4437
(971) 279-2757
Mailing address
1920 N KILLINGSWORTH ST, PORTLAND, OR 97217-4437
(971) 279-2757
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
69864495
OR
Other
Enumeration date
10/30/2012
Last updated
10/30/2012
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