Healthcare Provider Details

I. General information

NPI: 1477817674
Provider Name (Legal Business Name): BARBARA DAWN ZIBRIDA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 SW SHADY LN STE 303
TIGARD OR
97223-5481
US

IV. Provider business mailing address

9735 SW SHADY LN STE 303
TIGARD OR
97223-5481
US

V. Phone/Fax

Practice location:
  • Phone: 503-684-1273
  • Fax: 503-684-1274
Mailing address:
  • Phone: 503-684-1273
  • Fax: 503-684-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11280
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: