Provider Demographics
NPI:1619153657
Name:HAHN, ANDREW L (LMT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:HAHN
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 1:1005 SE 14TH AVE
Mailing Address - Street 2:#304
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2546
Mailing Address - Country:US
Mailing Address - Phone:503-975-6334
Mailing Address - Fax:
Practice Address - Street 1:1005 SE 14TH AVE
Practice Address - Street 2:#304
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2546
Practice Address - Country:US
Practice Address - Phone:503-975-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6346225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist