Provider Demographics
NPI:1578096954
Name:GRUBER, BRIANNA NOELLE (LMT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NOELLE
Last Name:GRUBER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:NOELLE
Other - Last Name:TOLLENAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11565 SW DURHAM RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3553
Mailing Address - Country:US
Mailing Address - Phone:503-639-0778
Mailing Address - Fax:
Practice Address - Street 1:11565 SW DURHAM RD
Practice Address - Street 2:SUITE 110
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3553
Practice Address - Country:US
Practice Address - Phone:503-639-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR023126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist