Provider Demographics
NPI:1699003350
Name:ERMATINGER, REBECCA JANE (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:ERMATINGER
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 1:11865 SW TUALATIN RD APT 76
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7075
Mailing Address - Country:US
Mailing Address - Phone:541-408-4122
Mailing Address - Fax:
Practice Address - Street 1:3990 COLLINS WAY
Practice Address - Street 2:STE 201
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3480
Practice Address - Country:US
Practice Address - Phone:503-635-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist