Provider Demographics
NPI:1447619705
Name:FLOWERS, TASHA (LMT,)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:FLOWERS
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 1:11155 SW HALL BLVD APT 99
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2447
Mailing Address - Country:US
Mailing Address - Phone:541-892-0191
Mailing Address - Fax:
Practice Address - Street 1:419 NW 23RD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3470
Practice Address - Country:US
Practice Address - Phone:541-892-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist