| Organization Name: | WILLAMETTE VALLEY WELLNESS LLC |
| NPI Number: | 1194069450 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSHUA R WOLFRAM (OWNER) |
| Mailing Address: | 4356 Commercial Street Se Salem |
| State: | OR US |
| Postal Code: | 97302 |
| Phone Number: | 5036891216 |
| Fax Number: | 5036891520 |
| NPI Enumeration Date: | 11/26/2012 |
| NPI Last Update Date: | 11/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 13553 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |