Provider Demographics
NPI:1205425949
Name:KEITH, CHRISTOPHER (LMT#26010)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:KEITH
Suffix:
Gender:M
Credentials:LMT#26010
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4072 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1223
Mailing Address - Country:US
Mailing Address - Phone:971-813-8821
Mailing Address - Fax:
Practice Address - Street 1:4072 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1223
Practice Address - Country:US
Practice Address - Phone:971-813-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist