Healthcare Provider Details

I. General information

NPI: 1982316329
Provider Name (Legal Business Name): KATHERINE KOCUREK ROLFER, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAT KOCUREK ROLFER, LMT

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 SE BELMONT ST STE 101B
PORTLAND OR
97214-4247
US

IV. Provider business mailing address

5536 SE SCHILLER ST
PORTLAND OR
97206-4868
US

V. Phone/Fax

Practice location:
  • Phone: 503-406-8890
  • Fax:
Mailing address:
  • Phone: 281-795-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27349
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: