Provider Demographics
NPI:1518146315
Name:BUCKALLEW, LILIANA APRIL (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LILIANA
Middle Name:APRIL
Last Name:BUCKALLEW
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 1:12550 SE 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6728
Mailing Address - Country:US
Mailing Address - Phone:503-698-6681
Mailing Address - Fax:
Practice Address - Street 1:3716 SE INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6001
Practice Address - Country:US
Practice Address - Phone:503-659-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11994225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist