Provider Demographics
NPI:1982844601
Name:GIANNETTI, JAMES P (LMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:GIANNETTI
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 1:158 NE BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2339
Mailing Address - Country:US
Mailing Address - Phone:503-867-5915
Mailing Address - Fax:
Practice Address - Street 1:158 NE BUFFALO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-2339
Practice Address - Country:US
Practice Address - Phone:503-867-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14777225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist