Healthcare Provider Details

I. General information

NPI: 1710930342
Provider Name (Legal Business Name): JULIE K ROBINSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 NE BROADWAY ST
PORTLAND OR
97232-1215
US

IV. Provider business mailing address

823 NE BROADWAY ST
PORTLAND OR
97232-1215
US

V. Phone/Fax

Practice location:
  • Phone: 503-892-8787
  • Fax: 503-282-9869
Mailing address:
  • Phone: 503-892-8787
  • Fax: 503-282-9869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: