Provider Demographics
NPI:1235775180
Name:FREE, JOSEPH CAMERON (LMT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CAMERON
Last Name:FREE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:YARROW
Other - Middle Name:
Other - Last Name:FREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1626 NE 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4252
Mailing Address - Country:US
Mailing Address - Phone:512-921-8162
Mailing Address - Fax:
Practice Address - Street 1:5010 NE 33RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6946
Practice Address - Country:US
Practice Address - Phone:512-921-8162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25225225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist