Athena Wrennette Rolph, LMT
Individual provider Active NPI Massage Therapist · Boring, OR
NPI 1114219110 · NPPES record last updated May 9, 2011
Key facts
- NPI
- 1114219110
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 18063 (OR)
- Practice address
- 11943 SE 362ND Ave
Boring, OR 97009-8720 - Phone
- (971) 409-0949
- Fax
- (503) 663-0664
- NPI assigned
- May 9, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18063 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Touch of Tranquility Massage | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 18063 | OR | Yes |
Addresses
Primary practice location
11943 SE 362ND Ave
Boring, OR 97009-8720
Mailing address
11943 SE 362ND Ave
Boring, OR 97009-8720
Phone (971) 409-0949
Other providers in Boring, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.