Provider Demographics
NPI:1093283889
Name:DOBREV, IAN MARINOV (LMT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:MARINOV
Last Name:DOBREV
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 1:677 WOODLEAF LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4052
Mailing Address - Country:US
Mailing Address - Phone:541-729-6330
Mailing Address - Fax:
Practice Address - Street 1:1508 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4048
Practice Address - Country:US
Practice Address - Phone:541-343-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist