Provider Demographics
NPI:1932389053
Name:TUNISON, TOBIN RAY (LMT)
Entity Type:Individual
Prefix:MR
First Name:TOBIN
Middle Name:RAY
Last Name:TUNISON
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 1:2080 SE OAK GROVE BLVD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2657
Mailing Address - Country:US
Mailing Address - Phone:971-237-4869
Mailing Address - Fax:
Practice Address - Street 1:2080 SE OAK GROVE BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2657
Practice Address - Country:US
Practice Address - Phone:971-237-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12232225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist