Provider Demographics
NPI:1700100872
Name:CORREA, ANDREAS MICHAEL (LMT, CCA)
Entity Type:Individual
Prefix:MR
First Name:ANDREAS
Middle Name:MICHAEL
Last Name:CORREA
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Gender:M
Credentials:LMT, CCA
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Mailing Address - Street 1:819 SE MORRISON ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-6307
Mailing Address - Country:US
Mailing Address - Phone:503-445-7999
Mailing Address - Fax:503-445-7997
Practice Address - Street 1:819 SE MORRISON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-6307
Practice Address - Country:US
Practice Address - Phone:503-445-7999
Practice Address - Fax:503-445-7997
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist