Healthcare Provider Details

I. General information

NPI: 1518215888
Provider Name (Legal Business Name): BRIAN PATRICK BARTHELEMY LAC, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 WILLAMETTE FALLS DR STE 130
WEST LINN OR
97068-4355
US

IV. Provider business mailing address

1085 WILLAMETTE FALLS DR STE 130
WEST LINN OR
97068-4355
US

V. Phone/Fax

Practice location:
  • Phone: 503-926-7810
  • Fax: 503-296-2100
Mailing address:
  • Phone: 503-926-7810
  • Fax: 503-296-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC186592
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21121
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: