Healthcare Provider Details

I. General information

NPI: 1912817701
Provider Name (Legal Business Name): WESTON LOAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 NW MARSHALL ST
PORTLAND OR
97209-2804
US

IV. Provider business mailing address

315 NW UPTOWN TER APT 3A
PORTLAND OR
97210-5606
US

V. Phone/Fax

Practice location:
  • Phone: 720-515-1227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29324
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: