Healthcare Provider Details

I. General information

NPI: 1356886808
Provider Name (Legal Business Name): MARY WHEELER, LMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 N POLK ST
EUGENE OR
97402-4108
US

IV. Provider business mailing address

67 N POLK ST
EUGENE OR
97402-4108
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-7339
  • Fax:
Mailing address:
  • Phone: 541-342-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number4677
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4677
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerSTATE OF OREGON BOARD OF MASSAGE THERAPISTS

VIII. Authorized Official

Name: MISS MARY HELEN WHEELER
Title or Position: OWNER
Credential: LMT
Phone: 541-342-7339