Provider Demographics
NPI:1295486082
Name:SALCEDO, REBECCA CHRISTINE (LMT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:CHRISTINE
Last Name:SALCEDO
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 1:5925 N DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4211
Mailing Address - Country:US
Mailing Address - Phone:971-271-0932
Mailing Address - Fax:
Practice Address - Street 1:5925 N DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4211
Practice Address - Country:US
Practice Address - Phone:971-271-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24082225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist