Breathe Body Spa, LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

22338 Issued in OR

Legal business name

BREATHE BODY SPA, LLC

Practice address

205 NE Ford St
McMinnville, OR 97128-4632

Phone

(971) 267-5227

NPI assigned

Sep 16, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Kelly Ryan Van Dyke, LMT

Title

Owner/LMT

Phone

(971) 267-5227

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1473984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473984000000",
    "number": "1588112676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 SE LOCUST ST",
            "city": "DUNDEE",
            "state": "OR",
            "postal_code": "971159630",
            "telephone_number": "503-915-6021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 NE FORD ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971284632",
            "telephone_number": "971-267-5227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREATHE BODY SPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-16",
        "last_updated": "2016-09-16",
        "status": "A",
        "authorized_official_last_name": "VAN DYKE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OWNER/LMT",
        "authorized_official_telephone_number": "971-267-5227",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "22338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED MASSAGE THERAPIST",
            "identifier": "22338",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane J Brandsma, M.A.
• Keely Brannigan, LPC
• Hallee Michelle Bratvold
• Lacee Braun
• Mason Brause
• Kaitlyn Broock Brewer
• McKaley Brewer, ATC/R
• Anna Thomas Briggs
• Cassie Elizabeth Brock
• Alexandra Nicole Brockman, DPT

• Massage Therapist in McMinnville, OR
• Providers in McMinnville, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.