Healthcare Provider Details

I. General information

NPI: 1679892137
Provider Name (Legal Business Name): MR. DUSTIN LINDSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18791 SW MARTINAZZI AVE SUITE 110B
TUALATIN OR
97062-6891
US

IV. Provider business mailing address

20632 SW ELK HORN CT
TUALATIN OR
97062-9518
US

V. Phone/Fax

Practice location:
  • Phone: 541-602-5261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15890
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: