Healthcare Provider Details

I. General information

NPI: 1801097449
Provider Name (Legal Business Name): RUTH VIOLA BRYANT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 NE HAMPTON CT
HILLSBORO OR
97124
US

IV. Provider business mailing address

PO BOX 3772
HILLSBORO OR
97123
US

V. Phone/Fax

Practice location:
  • Phone: 503-515-4293
  • Fax:
Mailing address:
  • Phone: 503-515-4293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7506
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: