Provider Demographics
NPI:1508017229
Name:ROE, RENEE LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:ROE
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 1:175 CUMMINGS LN N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5417
Mailing Address - Country:US
Mailing Address - Phone:503-362-1546
Mailing Address - Fax:
Practice Address - Street 1:175 CUMMINGS LN N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5417
Practice Address - Country:US
Practice Address - Phone:503-362-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14580225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist