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General NPI Number Information
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NPI Number | 1063860377
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Entity Type | Organization
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Legal Business Name | DENI R BUSS, LMT
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 14511 WESTLAKE DR SUITE 100
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-7783
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Country | US
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Telephone | 503-449-6939
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Fax | 503-598-3980
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Provider Business Mailing Address
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Address Line | 5914 SW GUNTHER LN
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City | PORTLAND
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State | OR
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Zip | 97219-7125
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Country | US
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Telephone | 503-449-6939
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | DENI R BUSS
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Credential | LMT
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Telephone | 503-449-6939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7324
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License Number State | OR
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