MEDICARE: ALAN ROBERT LILJENBERG 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	14709	OR

General Provider Information

NPI Number	:	1295007466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN ROBERT LILJENBERG LMT

Provider Business Mailing Address
First Line	:	1502 PIONEER CIR
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-3312
Country	:	US
Telephone Number	:	503-707-5379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 MOUNTAIN VIEW LN STE 400
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2248
Country	:	US
Telephone Number	:	503-707-5379
Fax Number	:

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

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	03/24/2016

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