Provider Demographics
NPI:1538451224
Name:ABSOLUTE BALANCE BODYWORK LLC
Entity type:Organization
Organization Name:ABSOLUTE BALANCE BODYWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:VARESIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-407-9055
Mailing Address - Street 1:12570 SE 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6728
Mailing Address - Country:US
Mailing Address - Phone:503-407-9055
Mailing Address - Fax:
Practice Address - Street 1:833 SE MAIN ST STE 428
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3433
Practice Address - Country:US
Practice Address - Phone:503-407-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17597225700000X
OR18132225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty