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General NPI Number Information
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NPI Number | 1275331605
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Entity Type | Organization
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Legal Business Name | ROSES THORN ELECTROLOGY GROUP LLC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 1954 SE 182ND AVE # 201
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City | PORTLAND
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State | OR
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Zip | 97233-5602
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Country | US
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Telephone | 503-660-8468
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Fax |
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Provider Business Mailing Address
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Address Line | 416 SE 34TH CIR
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City | TROUTDALE
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State | OR
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Zip | 97060-4505
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Country | US
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Telephone | 503-676-4799
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Fax |
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Authorized Official
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Title or Position | LICENSED ELECTROLOGIST
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Name | MAX L LAVALLEE
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Credential | LE
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Telephone | 503-676-4799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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