Provider Demographics
NPI:1942542477
Name:PURRY, EMILY JOHNSON (MS, LMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOHNSON
Last Name:PURRY
Suffix:
Gender:F
Credentials:MS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18573 SW MUIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3189
Mailing Address - Country:US
Mailing Address - Phone:503-516-5383
Mailing Address - Fax:
Practice Address - Street 1:18573 SW MUIRFIELD ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3189
Practice Address - Country:US
Practice Address - Phone:503-516-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12319171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor