Provider Demographics
NPI:1538445135
Name:AT EASE MASSAGE THERAPY, LLC
Entity type:Organization
Organization Name:AT EASE MASSAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DARYL
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-957-0338
Mailing Address - Street 1:15495 SW SEQUOIA PKWY.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-6117
Mailing Address - Country:US
Mailing Address - Phone:503-957-0338
Mailing Address - Fax:
Practice Address - Street 1:15495 SW SEQUOIA PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-6100
Practice Address - Country:US
Practice Address - Phone:503-957-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10755172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty