Provider Demographics
NPI:1457622284
Name:WESTLAKE MASSAGE THERAPY
Entity Type:Organization
Organization Name:WESTLAKE MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-598-8099
Mailing Address - Street 1:14511 WESTLAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7727
Mailing Address - Country:US
Mailing Address - Phone:503-598-8099
Mailing Address - Fax:
Practice Address - Street 1:14511 WESTLAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7727
Practice Address - Country:US
Practice Address - Phone:503-598-8099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X, 173C00000X, 175F00000X
OR6186175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty