Provider Demographics
NPI:1255688768
Name:VIERRA, SEAN MANLEY (LMT, ACMT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MANLEY
Last Name:VIERRA
Suffix:
Gender:M
Credentials:LMT, ACMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 LADINO PL W
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9689
Mailing Address - Country:US
Mailing Address - Phone:541-603-0820
Mailing Address - Fax:
Practice Address - Street 1:1034 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3440
Practice Address - Country:US
Practice Address - Phone:541-603-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19099173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist