Healthcare Provider Details

I. General information

NPI: 1477792448
Provider Name (Legal Business Name): JOHN EDWARD SEITZINGER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W ADAMS AVE # 103-E
SISTERS OR
97759-2517
US

IV. Provider business mailing address

803 NW DELAWARE AVE
BEND OR
97703-3229
US

V. Phone/Fax

Practice location:
  • Phone: 541-719-8634
  • Fax:
Mailing address:
  • Phone: 541-719-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-27436
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: