Healthcare Provider Details

I. General information

NPI: 1548734304
Provider Name (Legal Business Name): TRUDY MAE SCHORZMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 SE STARK ST STE 202
GRESHAM OR
97030-8328
US

IV. Provider business mailing address

PO BOX 1834
GRESHAM OR
97030-0553
US

V. Phone/Fax

Practice location:
  • Phone: 503-704-9990
  • Fax:
Mailing address:
  • Phone: 503-704-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18717
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: