Provider Demographics
NPI:1710476742
Name:RIVERS, RUNE ARCADE (LMT)
Entity Type:Individual
Prefix:
First Name:RUNE
Middle Name:ARCADE
Last Name:RIVERS
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 1:6504 WHEATLAND RD N APT 9
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4098
Mailing Address - Country:US
Mailing Address - Phone:971-990-9853
Mailing Address - Fax:
Practice Address - Street 1:156 CHEMAWA RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5356
Practice Address - Country:US
Practice Address - Phone:503-999-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24068225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist