Provider Demographics
NPI:1639580814
Name:JAMESON, ALEXANDER MATTHEW ANDREW (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MATTHEW ANDREW
Last Name:JAMESON
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 1:14358 SE VILLAGE SLOPE CT
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6397
Mailing Address - Country:US
Mailing Address - Phone:503-740-3040
Mailing Address - Fax:
Practice Address - Street 1:3 MONROE PKWY
Practice Address - Street 2:SUITE U
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1486
Practice Address - Country:US
Practice Address - Phone:503-387-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-10
Last Update Date:2014-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18653225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist