Healthcare Provider Details

I. General information

NPI: 1821213596
Provider Name (Legal Business Name): ARTI MITRA BOYD L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 NE SANDY BLVD SUITE 200
PORTLAND OR
97213-2091
US

IV. Provider business mailing address

3126 NE AINSWORTH ST
PORTLAND OR
97211-6722
US

V. Phone/Fax

Practice location:
  • Phone: 503-287-1510
  • Fax:
Mailing address:
  • Phone: 503-260-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12378
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: