Provider Demographics
NPI:1295052488
Name:COUCH, CHERYL ANN (LMT)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:COUCH
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 1:1407 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-1115
Mailing Address - Country:US
Mailing Address - Phone:503-293-1291
Mailing Address - Fax:503-293-6359
Practice Address - Street 1:1407 ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-1115
Practice Address - Country:US
Practice Address - Phone:503-293-1291
Practice Address - Fax:503-293-6359
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist