Provider Demographics
NPI:1821536533
Name:BUSS, DENI R (LMT)
Entity Type:Individual
Prefix:
First Name:DENI
Middle Name:R
Last Name:BUSS
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 1:5914 SW GUNTHER LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7125
Mailing Address - Country:US
Mailing Address - Phone:503-449-6939
Mailing Address - Fax:503-598-3980
Practice Address - Street 1:16083 SW UPPER BOONES FERRY RD STE 130
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7737
Practice Address - Country:US
Practice Address - Phone:503-449-6939
Practice Address - Fax:503-477-5865
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist