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Contact Information

BODYWORK FOR THE ACTIVE
2701 NW VAUGHN ST STE 154
PORTLAND, OR97210-5349
 Phone: 971-246-0057
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Mechanotherapist

172M00000X
Indicates primary specialty

NPI Profile & details for BODYWORK FOR THE ACTIVE

NPI # 1528486982
LBN Legal business name BODYWORK FOR THE ACTIVE
Authorized official RICARD DEAUSTRIA - (OWNER/LMT)
Entity Organization
Organization subpart 1 No
Enumeration date 04/02/2014
Last updated 04/02/2014 - About 12 years ago
Identifiers
OR License # 15490
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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