Healthcare Provider Details

I. General information

NPI: 1629653233
Provider Name (Legal Business Name): CYNTHIA WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N VILLA RD
NEWBERG OR
97132-1800
US

IV. Provider business mailing address

1701 N MEADOW LN
NEWBERG OR
97132-1501
US

V. Phone/Fax

Practice location:
  • Phone: 503-305-6585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22916
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: