Provider Demographics
NPI:1649631755
Name:COLSON, BRYCE LYLE (LMT)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:LYLE
Last Name:COLSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11090 BEUTEL RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9795
Mailing Address - Country:US
Mailing Address - Phone:971-678-3790
Mailing Address - Fax:
Practice Address - Street 1:5336 SE BUSH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5394
Practice Address - Country:US
Practice Address - Phone:971-678-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21960225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist