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General NPI Number Information
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NPI Number | 1134507346
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Entity Type | Individual
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Provider Name | BETH LOPEZ LMT
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Gender | Female
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 5814 SE STARK STREET
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City | PORTLAND
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State | OR
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Zip | 97216
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Country | US
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Telephone | 971-266-4037
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Fax |
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Provider Business Mailing Address
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Address Line | 5614 SE STARK STREET
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City | PORTLAND
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State | OR
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Zip | 97216
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Country | US
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Telephone | 203-213-0856
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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 | 21312
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License Number State | OR
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