Provider Demographics
NPI:1548665508
Name:MASSAGE BY ERICA
Entity type:Organization
Organization Name:MASSAGE BY ERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:CHRISTEL
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:971-409-8362
Mailing Address - Street 1:56450 NEHALEM HWY S
Mailing Address - Street 2:
Mailing Address - City:VERNONIA
Mailing Address - State:OR
Mailing Address - Zip Code:97064-9611
Mailing Address - Country:US
Mailing Address - Phone:971-409-8362
Mailing Address - Fax:
Practice Address - Street 1:56450 NEHALEM HWY S
Practice Address - Street 2:
Practice Address - City:VERNONIA
Practice Address - State:OR
Practice Address - Zip Code:97064-9611
Practice Address - Country:US
Practice Address - Phone:971-409-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-01
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12712225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty