Provider Demographics
NPI:1629125224
Name:SLAUGHTER, ISAAC GRANT (LMT)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:GRANT
Last Name:SLAUGHTER
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 1:15915 S BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:MULINO
Mailing Address - State:OR
Mailing Address - Zip Code:97042-9755
Mailing Address - Country:US
Mailing Address - Phone:503-545-8303
Mailing Address - Fax:
Practice Address - Street 1:707 7TH ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2346
Practice Address - Country:US
Practice Address - Phone:503-545-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13303225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist