Provider Demographics
NPI:1063818839
Name:SANDS, JOAN V (LMT, LMP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:V
Last Name:SANDS
Suffix:
Gender:F
Credentials:LMT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 SE LAVA DR APT 21
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-3401
Mailing Address - Country:US
Mailing Address - Phone:503-919-0311
Mailing Address - Fax:
Practice Address - Street 1:2250 NW FLANDERS ST STE 304
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5411
Practice Address - Country:US
Practice Address - Phone:503-919-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8301225700000X
WAMA00018818225700000X
HIMAT-17507225700000X
OR7879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist