Provider Demographics
NPI:1578847075
Name:LAY, ROBERT (LMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:LAY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SE ORIENT DR
Mailing Address - Street 2:129
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7278
Mailing Address - Country:US
Mailing Address - Phone:503-995-1912
Mailing Address - Fax:
Practice Address - Street 1:1717 SE ORIENT DR
Practice Address - Street 2:129
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-7278
Practice Address - Country:US
Practice Address - Phone:503-995-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17446225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist