Provider Demographics
NPI:1619588514
Name:MURRAY, TIFFANY RAE (LMT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RAE
Last Name:MURRAY
Suffix:
Gender:F
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:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-0046
Mailing Address - Country:US
Mailing Address - Phone:541-272-9346
Mailing Address - Fax:
Practice Address - Street 1:698 NE STEENSON RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-9564
Practice Address - Country:US
Practice Address - Phone:541-272-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5027225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist