Healthcare Provider Details

I. General information

NPI: 1104757103
Provider Name (Legal Business Name): ROBERT MICHAEL LOREN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 OCEAN BEACH HWY STE 116
LONGVIEW WA
98632-4081
US

IV. Provider business mailing address

909 S 5TH AVE
KELSO WA
98626-2521
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-3220
  • Fax: 360-353-5350
Mailing address:
  • Phone: 360-562-2046
  • Fax: 360-353-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.61634601
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: