Provider Demographics
NPI:1922201656
Name:KNUTSON, STEPHENIE MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:MICHELLE
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NOVA
Other - Middle Name:
Other - Last Name:KNUTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2705 NE WEIDLER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1746
Mailing Address - Country:US
Mailing Address - Phone:503-358-5263
Mailing Address - Fax:503-288-4846
Practice Address - Street 1:2705 NE WEIDLER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1746
Practice Address - Country:US
Practice Address - Phone:503-358-5263
Practice Address - Fax:503-288-4846
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6440225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist