Provider Demographics
NPI:1295287068
Name:AUTHENTIC MASSAGE THERAPY LLC
Entity type:Organization
Organization Name:AUTHENTIC MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HOPPE
Authorized Official - Suffix:
Authorized Official - Credentials:MMP
Authorized Official - Phone:312-532-3070
Mailing Address - Street 1:14631 SW MILLIKAN WAY STE 14
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2999
Mailing Address - Country:US
Mailing Address - Phone:312-532-3070
Mailing Address - Fax:971-228-2151
Practice Address - Street 1:14631 SW MILLIKAN WAY STE 14
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-2999
Practice Address - Country:US
Practice Address - Phone:312-532-3070
Practice Address - Fax:971-228-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21414225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty