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General NPI Number Information
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NPI Number | 1225468788
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Entity Type | Individual
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Provider Name | ANDREA BLUM LMT
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Gender | Female
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 443 NE KNOTT ST
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City | PORTLAND
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State | OR
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Zip | 97212-3108
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Country | US
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Telephone | 503-941-0152
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Fax | 503-282-0464
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Provider Business Mailing Address
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Address Line | 6948 N MONTANA AVE
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City | PORTLAND
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State | OR
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Zip | 97217-5432
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Country | US
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Telephone | 415-515-6152
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Fax | 503-282-0464
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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 | 29391
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 24741
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License Number State | OR
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