Healthcare Provider Details

I. General information

NPI: 1932204104
Provider Name (Legal Business Name): ANTHONY RYAN BROWN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 Q ST
SPRINGFIELD OR
97477-2120
US

IV. Provider business mailing address

380 Q ST
SPRINGFIELD OR
97477-2120
US

V. Phone/Fax

Practice location:
  • Phone: 541-606-5954
  • Fax:
Mailing address:
  • Phone: 541-606-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12999
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: