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General NPI Number Information
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NPI Number | 1154471209
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Entity Type | Individual
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Provider Name | DAVID MICHAEL THOMAS LMT
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1330 SE 39TH AVE
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City | PORTLAND
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State | OR
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Zip | 97214-4322
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Country | US
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Telephone | 503-232-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 1707 SE 33RD AVE
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City | PORTLAND
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State | OR
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Zip | 97214-5024
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Country | US
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Telephone | 503-929-7599
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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 | 12740
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License Number State | OR
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