Healthcare Provider Details

I. General information

NPI: 1295117794
Provider Name (Legal Business Name): REBECCA CLARE RYDER-NABER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 NE 47TH AVE
PORTLAND OR
97213-2064
US

IV. Provider business mailing address

4223 SE 74TH AVE
PORTLAND OR
97206-3415
US

V. Phone/Fax

Practice location:
  • Phone: 503-282-7581
  • Fax:
Mailing address:
  • Phone: 503-481-4821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21396
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: