Provider Demographics
NPI:1184070443
Name:GROUNDED FLOW
Entity type:Organization
Organization Name:GROUNDED FLOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-724-7122
Mailing Address - Street 1:5955 BURMA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3239
Mailing Address - Country:US
Mailing Address - Phone:503-568-5746
Mailing Address - Fax:
Practice Address - Street 1:12085 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6253
Practice Address - Country:US
Practice Address - Phone:503-724-7122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty