Healthcare Provider Details

I. General information

NPI: 1073952115
Provider Name (Legal Business Name): CYNTHIA ANN GELLINGER LMT, CMLDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CINDY ANN GELLINGER LMT, CMLDT

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 B AVE SUITE L
LAKE OSWEGO OR
97034-3055
US

IV. Provider business mailing address

1669 OAK ST
LAKE OSWEGO OR
97034-4747
US

V. Phone/Fax

Practice location:
  • Phone: 503-752-1458
  • Fax:
Mailing address:
  • Phone: 503-752-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number19296
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: