Healthcare Provider Details

I. General information

NPI: 1124359088
Provider Name (Legal Business Name): STEVE J DAVIS RYT, LMT, NCTMB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CENTERPOINTE DR SUITE 400
LAKE OSWEGO OR
97035-8651
US

IV. Provider business mailing address

PO BOX 1221
LAKE OSWEGO OR
97035-0518
US

V. Phone/Fax

Practice location:
  • Phone: 503-724-2755
  • Fax:
Mailing address:
  • Phone: 503-724-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13099
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberYA#29243
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number512195-6
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: