Provider Demographics
NPI:1841365046
Name:PROHASKA, TERESA MARIE (LMT LFT)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARIE
Last Name:PROHASKA
Suffix:
Gender:F
Credentials:LMT LFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 SE THIRD AVENUE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-844-9355
Mailing Address - Fax:503-640-6924
Practice Address - Street 1:343 SE THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123
Practice Address - Country:US
Practice Address - Phone:503-844-9355
Practice Address - Fax:503-640-6924
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist