Provider Demographics
NPI:1043554637
Name:HUGHLEY, NICHOLAS P (LMT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:HUGHLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16501 NE RUSSELL ST
Mailing Address - Street 2:APT. 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5956
Mailing Address - Country:US
Mailing Address - Phone:503-407-7352
Mailing Address - Fax:
Practice Address - Street 1:8383 NE SANDY BLVD
Practice Address - Street 2:SUITE 320DD
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4948
Practice Address - Country:US
Practice Address - Phone:503-407-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16624225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist