Healthcare Provider Details

I. General information

NPI: 1669593299
Provider Name (Legal Business Name): SALLY JO ARMSTRONG LMT, CA, NCTMB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 SW CORBETT AVE
PORTLAND OR
97239-4260
US

IV. Provider business mailing address

PO BOX 185
BEAVERTON OR
97075-0185
US

V. Phone/Fax

Practice location:
  • Phone: 503-225-9033
  • Fax: 503-225-9039
Mailing address:
  • Phone: 503-225-9033
  • Fax: 503-225-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number#O6234
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: