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General NPI Number Information
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NPI Number | 1134446842
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Entity Type | Individual
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Provider Name | JEAN LOUISE ZUELKE LMT
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Gender | Female
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 333 S STATE ST SUITE W
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3932
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Country | US
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Telephone | 503-636-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 1470 SW MAPLECREST DR
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City | PORTLAND
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State | OR
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Zip | 97219-6434
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Country | US
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Telephone | 503-245-7837
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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 | 2721
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License Number State | OR
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