Provider Demographics
NPI:1063860377
Name:DENI R BUSS, LMT
Entity Type:Organization
Organization Name:DENI R BUSS, LMT
Other - Org Name:DENI R BUSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DENI
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUSS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-449-6939
Mailing Address - Street 1:5914 SW GUNTHER LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7125
Mailing Address - Country:US
Mailing Address - Phone:503-449-6939
Mailing Address - Fax:
Practice Address - Street 1:14511 WESTLAKE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7783
Practice Address - Country:US
Practice Address - Phone:503-449-6939
Practice Address - Fax:503-598-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7324261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center