Provider Demographics
NPI:1518700145
Name:RITUAL MASSAGE AND BODYWORK
Entity type:Organization
Organization Name:RITUAL MASSAGE AND BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:260-750-8399
Mailing Address - Street 1:916 NE TILLAMOOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4058
Mailing Address - Country:US
Mailing Address - Phone:260-750-8399
Mailing Address - Fax:
Practice Address - Street 1:407 NW 17TH AVE # 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2247
Practice Address - Country:US
Practice Address - Phone:260-750-8399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty