Healthcare Provider Details

I. General information

NPI: 1679478614
Provider Name (Legal Business Name): LMT LAURA PDX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23216 SW DARBY AVE
TUALATIN OR
97062-7656
US

IV. Provider business mailing address

23216 SW DARBY AVE
TUALATIN OR
97062-7656
US

V. Phone/Fax

Practice location:
  • Phone: 503-729-1838
  • Fax:
Mailing address:
  • Phone: 503-729-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURA A PIERCE
Title or Position: OWNER/LMT
Credential:
Phone: 503-729-1838