MEDICARE: ANDREA BLUM LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	29391	CA
2	225700000X	Massage Therapist	24741	OR

General Provider Information

NPI Number	:	1225468788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BLUM LMT

Provider Business Mailing Address
First Line	:	6948 N MONTANA AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5432
Country	:	US
Telephone Number	:	415-515-6152
Fax Number	:	503-282-0464

Provider Business Practice Location Address
First Line	:	443 NE KNOTT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-3108
Country	:	US
Telephone Number	:	503-941-0152
Fax Number	:	503-282-0464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	07/09/2019

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Directions to “ ANDREA BLUM LMT” Practice Location

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