Healthcare Provider Details

I. General information

NPI: 1942490651
Provider Name (Legal Business Name): JERRIE LEE PARPART LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2007
Last Update Date: 07/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3789 RIVER RD N SUITE D
KEIZER OR
97303-4825
US

IV. Provider business mailing address

3789 RIVER RD N SUITE D
KEIZER OR
97303-4825
US

V. Phone/Fax

Practice location:
  • Phone: 503-856-9519
  • Fax:
Mailing address:
  • Phone: 503-856-9519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT#10580
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: