NPI 1205779089 · live from the CMS NPI Registry
Active Wellness Center LLC
Massage Therapist in Bend, OR. National Provider Identifier 1205779089, active.
NPI record
| NPI | 1205779089 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Massage Therapist 225700000X |
| Practice location | 593 Nw York Dr, Bend, OR 97703 |
| Practice phone | 541-948-0993 |
| Mailing address | 20714 Snow Peaks Dr, Bend, OR 97701 |
| Enumerated | April 14, 2026 |
| Last updated | April 14, 2026 |
| Authorized official | Mark Dejohn, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Massage Therapist primary | 225700000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.