Provider Demographics
NPI:1275804478
Name:ESPINOSA, ARIELLE ROSE (LMT)
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:ROSE
Last Name:ESPINOSA
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 1:1036 N SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2253
Mailing Address - Country:US
Mailing Address - Phone:503-421-1887
Mailing Address - Fax:
Practice Address - Street 1:123 E POWELL BLVD STE 302
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7620
Practice Address - Country:US
Practice Address - Phone:503-421-1887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17430225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist