Provider Demographics
NPI:1598034050
Name:VALENTI, MICHAEL (BA, CR, LMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:VALENTI
Suffix:
Gender:M
Credentials:BA, CR, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 NE 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2407
Mailing Address - Country:US
Mailing Address - Phone:847-714-4078
Mailing Address - Fax:
Practice Address - Street 1:2330 NW FLANDERS ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3400
Practice Address - Country:US
Practice Address - Phone:503-701-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist