Healthcare Provider Details

I. General information

NPI: 1639918832
Provider Name (Legal Business Name): QUINN LINDEN GUMBINER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SE SPOKANE ST STE 300
PORTLAND OR
97202-6487
US

IV. Provider business mailing address

2130 N KILPATRICK ST UNIT 17603
PORTLAND OR
97217-0019
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-9159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27580
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: