Organization
THERAPEUTIC INTEGRATIVE MASSAGE & EXERCISE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA JOANNE ALLEN LMT (ORGANIZER)
(503) 709-1568
Entity
Organization
Contact information
Practice address
9860 SW HALL BLVD STE A, TIGARD, OR 97223-8896
(503) 709-1568
Mailing address
2604 SW 64TH PL, PORTLAND, OR 97225-8168
(503) 709-1568
(503) 709-1568
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
7084
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7084
MASSAGE LICENSE
OR
Enumeration date
05/08/2007
Last updated
08/22/2020
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