Innergized Movement Massage

Primary specialty

MechanotherapistTaxonomy code 172M00000X

License

20452 Issued in OR

Legal business name

INNERGIZED MOVEMENT MASSAGE

Practice address

21045 Bayou Dr
Bend, OR 97702-2437

Phone

(541) 771-2490

NPI assigned

Mar 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Crystal Dawn Olson, LMT

Title

Owner/Operator

Phone

(541) 771-2490

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1386004208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 NE 3RD ST STE 106",
            "address_2": "MAILBOX #170",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013889",
            "telephone_number": "541-771-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21045 BAYOU DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022437",
            "telephone_number": "541-771-2490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERGIZED MOVEMENT MASSAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-04",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "541-771-2490",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "172M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Mechanotherapist",
            "state": "OR",
            "license": "20452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.