Provider Demographics
NPI:1598983421
Name:SABER, NEISSAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:NEISSAN
Middle Name:
Last Name:SABER
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 1:80 OSWEGO SMT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1077
Mailing Address - Country:US
Mailing Address - Phone:503-449-2135
Mailing Address - Fax:
Practice Address - Street 1:4309 SE WOODSTOCK BLVD
Practice Address - Street 2:#120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6212
Practice Address - Country:US
Practice Address - Phone:503-449-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist