Provider Demographics
NPI:1730678129
Name:MONROY, THERESA (LMT#24232)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:MONROY
Suffix:
Gender:F
Credentials:LMT#24232
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SE 146TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-2512
Mailing Address - Country:US
Mailing Address - Phone:503-270-9133
Mailing Address - Fax:
Practice Address - Street 1:1001 SE 146TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2512
Practice Address - Country:US
Practice Address - Phone:503-270-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24232225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist