Provider Demographics
NPI:1881160539
Name:PEARCE, DAWN (LMT)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:PEARCE
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 1:1017 SW MORRISON ST STE 404
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2629
Mailing Address - Country:US
Mailing Address - Phone:702-824-5820
Mailing Address - Fax:
Practice Address - Street 1:1017 SW MORRISON ST STE 404
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2629
Practice Address - Country:US
Practice Address - Phone:702-824-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty