Healthcare Provider Details

I. General information

NPI: 1043345267
Provider Name (Legal Business Name): ANGELA JEAN DAVIS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18039 SW LOWER BOONES FERRY RD
TIGARD OR
97224-7228
US

IV. Provider business mailing address

9025 SW OAK ST
TIGARD OR
97223-6547
US

V. Phone/Fax

Practice location:
  • Phone: 503-481-4945
  • Fax:
Mailing address:
  • Phone: 503-481-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11689
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: