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General NPI Number Information
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NPI Number | 1073025656
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Entity Type | Individual
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Provider Name | VANESSA RAE GREENE MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 4535 SW 96TH AVE
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City | BEAVERTON
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State | OR
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Zip | 97005-3329
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Country | US
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Telephone | 971-801-4637
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Fax |
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Provider Business Mailing Address
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Address Line | 3628 SE WAKE ST UNIT B
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City | MILWAUKIE
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State | OR
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Zip | 97222-5696
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Country | US
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Telephone |
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Fax |
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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 | 21779
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License Number State | OR
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