Provider Demographics
NPI:1255110706
Name:WHITE, EMILY (LMT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10395 SW JOHNSON CT APT 308
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5229
Mailing Address - Country:US
Mailing Address - Phone:360-580-5041
Mailing Address - Fax:
Practice Address - Street 1:3944 N MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1163
Practice Address - Country:US
Practice Address - Phone:503-507-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26513225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist