Healthcare Provider Details

I. General information

NPI: 1255688768
Provider Name (Legal Business Name): SEAN MANLEY VIERRA LMT, ACMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 LAWRENCE ST
EUGENE OR
97401-3440
US

IV. Provider business mailing address

835 LADINO PL W
HARRISBURG OR
97446-9689
US

V. Phone/Fax

Practice location:
  • Phone: 541-603-0820
  • Fax:
Mailing address:
  • Phone: 541-603-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number19099
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number19099
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: