Provider Demographics
NPI:1417227885
Name:WEISS, BRIAN JEFFREY (LMT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JEFFREY
Last Name:WEISS
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 1:14511 WESTLAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7727
Mailing Address - Country:US
Mailing Address - Phone:503-598-8099
Mailing Address - Fax:
Practice Address - Street 1:14511 WESTLAKE DRIVE
Practice Address - Street 2:SUITE # 100
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-598-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15520225700000X
WAMA 60117543225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist