Provider Demographics
NPI:1518215888
Name:BARTHELEMY, BRIAN PATRICK (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:BARTHELEMY
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SE MADISON ST STE 216
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4527
Mailing Address - Country:US
Mailing Address - Phone:503-926-7810
Mailing Address - Fax:503-296-2100
Practice Address - Street 1:80 SE MADISON ST STE 216
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4527
Practice Address - Country:US
Practice Address - Phone:503-926-7810
Practice Address - Fax:503-296-2100
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG002475171W00000X
OR21121225700000X
ORAC186592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No171W00000XOther Service ProvidersContractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist