Provider Demographics
NPI:1649456203
Name:NYVLT, BLANKA (LMT)
Entity type:Individual
Prefix:
First Name:BLANKA
Middle Name:
Last Name:NYVLT
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 1:4629 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5453
Mailing Address - Country:US
Mailing Address - Phone:503-803-6671
Mailing Address - Fax:503-670-4954
Practice Address - Street 1:7357 SW BEVELAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8844
Practice Address - Country:US
Practice Address - Phone:503-670-4941
Practice Address - Fax:503-670-4954
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11749172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist