Healthcare Provider Details

I. General information

NPI: 1386940161
Provider Name (Legal Business Name): JANET KATHLEEN WEISER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20595 SW TUALATIN VALLEY HWY SUITE 201C
BEAVERTON OR
97006-1767
US

IV. Provider business mailing address

20595 SW TUALATIN VALLEY HWY SUITE 201C
BEAVERTON OR
97006-1767
US

V. Phone/Fax

Practice location:
  • Phone: 503-869-0651
  • Fax:
Mailing address:
  • Phone: 503-869-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17696
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: