Provider Demographics
NPI:1275002990
Name:DEAL, LANCE EARL (LMT)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:EARL
Last Name:DEAL
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 1:845 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-6501
Mailing Address - Country:US
Mailing Address - Phone:541-520-7721
Mailing Address - Fax:
Practice Address - Street 1:1166 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4616
Practice Address - Country:US
Practice Address - Phone:541-520-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10245OtherOREGON BOARD OF MASSAGE THERAPY