Healthcare Provider Details

I. General information

NPI: 1326703810
Provider Name (Legal Business Name): MARTIN SKOVIERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8113 SE 13TH AVE
PORTLAND OR
97202-6607
US

IV. Provider business mailing address

16777 SE RIVER RD
MILWAUKIE OR
97267-4506
US

V. Phone/Fax

Practice location:
  • Phone: 503-451-3926
  • Fax:
Mailing address:
  • Phone: 503-758-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26364
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: