Provider Demographics
NPI:1295038388
Name:DUECK, HIROMI ANDO (LMT)
Entity Type:Individual
Prefix:
First Name:HIROMI
Middle Name:ANDO
Last Name:DUECK
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 1:211 SE 105TH AVE
Mailing Address - Street 2:#Q104
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2786
Mailing Address - Country:US
Mailing Address - Phone:503-888-9830
Mailing Address - Fax:
Practice Address - Street 1:211 SE 105TH AVE
Practice Address - Street 2:#Q104
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2786
Practice Address - Country:US
Practice Address - Phone:503-888-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist