Healthcare Provider Details

I. General information

NPI: 1699003350
Provider Name (Legal Business Name): REBECCA JANE ERMATINGER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 COLLINS WAY STE 201
LAKE OSWEGO OR
97035-3480
US

IV. Provider business mailing address

11865 SW TUALATIN RD APT 76
TUALATIN OR
97062-7075
US

V. Phone/Fax

Practice location:
  • Phone: 503-635-1236
  • Fax:
Mailing address:
  • Phone: 541-408-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14955
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: