Provider Demographics
NPI:1417538158
Name:LEMASTERS, IAN COLLIER (LMT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:COLLIER
Last Name:LEMASTERS
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 1:5262 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6240
Mailing Address - Country:US
Mailing Address - Phone:409-656-6465
Mailing Address - Fax:
Practice Address - Street 1:4927 NE 30TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-7007
Practice Address - Country:US
Practice Address - Phone:503-281-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26256225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist