Organization
GRESHAM BALANCE BODY WORKS LLC
Active
Other names
Lindsay Wells, LMT
Organization subpart
No
Provider details
NPI number
Authorized official
LINDSAY LINDALA (OWNER)
(541) 510-8476
Entity
Organization
Contact information
Practice address
22400 SE STARK ST, GRESHAM, OR 97030
(541) 510-8476
(503) 907-0098
Mailing address
22400 SE STARK ST, GRESHAM, OR 97030-2656
(541) 510-8476
(503) 907-0099
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13478
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962678755
NPI TYPE 1
OR
Enumeration date
07/17/2012
Last updated
10/24/2014
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