Organization
MASSAGE IN CENTRAL OREGON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEFAN DAUTEUIL LMT (OWNER)
(808) 280-1776
Entity
Organization
Contact information
Practice address
57031 PONDEROSA ROAD, BLD 27 STE M2, SUNRIVER, OR 97707
(808) 280-1776
Mailing address
16675 MASTEN MILL DR, LA PINE, OR 97739-8708
(808) 280-1776
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
05/01/2023
Last updated
04/09/2024
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