Provider Demographics
NPI:1851431167
Name:CANFIELD, JUSTIN (LMT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:CANFIELD
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 1:12653 SW METTA TER
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5737
Mailing Address - Country:US
Mailing Address - Phone:503-313-0430
Mailing Address - Fax:
Practice Address - Street 1:5935 WILLOW LN
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5344
Practice Address - Country:US
Practice Address - Phone:503-655-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12411225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist