Healthcare Provider Details

I. General information

NPI: 1437162401
Provider Name (Legal Business Name): JOHN LAUREN COMBE LMT, NCTMB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 4TH ST
LA GRANDE OR
97850-2102
US

IV. Provider business mailing address

1002 4TH ST
LA GRANDE OR
97850-2102
US

V. Phone/Fax

Practice location:
  • Phone: 541-993-9355
  • Fax:
Mailing address:
  • Phone: 541-993-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7492
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: