Provider Demographics
NPI:1841790615
Name:FURUKAWA, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:FURUKAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 JUNTURA CT S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2348
Mailing Address - Country:US
Mailing Address - Phone:503-580-4815
Mailing Address - Fax:
Practice Address - Street 1:1825 JUNTURA CT S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2348
Practice Address - Country:US
Practice Address - Phone:503-580-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5677225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5677OtherOREGON STATE BOARD OF MASSAGE THERAPY