Provider Demographics
NPI:1043763980
Name:CLINE, MICHAEL TRE JR (LMT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TRE
Last Name:CLINE
Suffix:JR
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 1:1505 WHITAKER DR SE
Mailing Address - Street 2:#201
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5912
Mailing Address - Country:US
Mailing Address - Phone:503-269-2108
Mailing Address - Fax:
Practice Address - Street 1:1505 WHITAKER DR SE
Practice Address - Street 2:#201
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-5912
Practice Address - Country:US
Practice Address - Phone:503-269-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist