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General NPI Number Information
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NPI Number | 1194497271
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Entity Type | Individual
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Provider Name | JONATHAN PIERCE BCSI LMT
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Gender | Male
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 1411 NE BROADWAY ST
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City | PORTLAND
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State | OR
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Zip | 97232-1485
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Country | US
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Telephone | 480-438-6110
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Fax |
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Provider Business Mailing Address
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Address Line | 3615 NE 72ND AVE
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City | PORTLAND
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State | OR
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Zip | 97213-5705
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Country | US
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Telephone | 480-438-6110
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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 | 26338
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License Number State | OR
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