Provider Demographics
NPI:1386859346
Name:PFOTZER-GREENWOOD, MARY E (LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:PFOTZER-GREENWOOD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:GREENWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:965 IMPERIAL DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1319
Mailing Address - Country:US
Mailing Address - Phone:503-399-9810
Mailing Address - Fax:
Practice Address - Street 1:3789 RIVER RD N STE D
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4825
Practice Address - Country:US
Practice Address - Phone:503-856-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist