Provider Demographics
NPI:1982724795
Name:ROSKOPF, RICHARD WALTER (LMT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WALTER
Last Name:ROSKOPF
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 1:11507 SW SHILO LANE
Mailing Address - Street 2:STE E
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:503-939-2524
Mailing Address - Fax:503-520-0514
Practice Address - Street 1:11507 SW SHILO LANE
Practice Address - Street 2:STE E
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-939-2524
Practice Address - Fax:503-520-0514
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9601225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist