Provider Demographics
NPI:1093403495
Name:PIERCE, REBECCA JANE (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5118 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6325
Mailing Address - Country:US
Mailing Address - Phone:971-666-8196
Mailing Address - Fax:
Practice Address - Street 1:1733 SE MORRISON ST UNIT 731B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2728
Practice Address - Country:US
Practice Address - Phone:971-666-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist