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General NPI Number Information
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NPI Number | 1033653712
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Entity Type | Individual
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Provider Name | DANIELLE LUECK LMT
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Gender | Female
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 13305 NW CORNELL RD STE E
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City | PORTLAND
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State | OR
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Zip | 97229-5987
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Country | US
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Telephone | 503-746-5085
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Fax | 503-972-1185
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Provider Business Mailing Address
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Address Line | 13305 NW CORNELL RD STE E
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City | PORTLAND
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State | OR
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Zip | 97229-5987
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Country | US
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Telephone | 503-746-5085
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Fax | 503-972-1185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 21904
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License Number State | OR
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