Provider Demographics
NPI:1780345371
Name:BREINHOLT, ROBERT MICHAEL (LMT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:BREINHOLT
Suffix:
Gender:
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:PO BOX 13417
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-1417
Mailing Address - Country:US
Mailing Address - Phone:503-931-9237
Mailing Address - Fax:503-386-2263
Practice Address - Street 1:659 COTTAGE ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2419
Practice Address - Country:US
Practice Address - Phone:503-931-9237
Practice Address - Fax:503-386-2263
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26479225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist