Provider Demographics
NPI:1972029429
Name:EXCOFFIER, NAT (LMT)
Entity Type:Individual
Prefix:
First Name:NAT
Middle Name:
Last Name:EXCOFFIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BERNAT
Other - Middle Name:F
Other - Last Name:EXCOFFIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 11203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-0203
Mailing Address - Country:US
Mailing Address - Phone:510-409-0927
Mailing Address - Fax:
Practice Address - Street 1:1359 NE 35TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1941
Practice Address - Country:US
Practice Address - Phone:503-389-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR023163225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist