Provider Demographics
NPI:1578729893
Name:MATTHEWS, TINA LOUISE
Entity Type:Individual
Prefix:MISS
First Name:TINA
Middle Name:LOUISE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3600 AVE G # 66
Mailing Address - Street 2:
Mailing Address - City:WHITE CIT;Y
Mailing Address - State:OR
Mailing Address - Zip Code:97503-1255
Mailing Address - Country:US
Mailing Address - Phone:541-261-5274
Mailing Address - Fax:
Practice Address - Street 1:151 WEST LINN RD
Practice Address - Street 2:F6
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524
Practice Address - Country:US
Practice Address - Phone:541-830-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12870225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist