Provider Demographics
NPI:1598322554
Name:LEUNG, AUBREY (LMT)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:LEUNG
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 1:11111 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2228
Mailing Address - Country:US
Mailing Address - Phone:541-250-9420
Mailing Address - Fax:
Practice Address - Street 1:516 SE MORRISON ST STE 217
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2342
Practice Address - Country:US
Practice Address - Phone:541-250-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24026225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist