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General NPI Number Information
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NPI Number | 1366606030
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Entity Type | Individual
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Provider Name | ANDREW TOAN PHAM LMT
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Gender | Male
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 4445 SW BARBUR BLVD STE 104
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City | PORTLAND
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State | OR
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Zip | 97239-4047
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Country | US
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Telephone | 503-226-0796
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Fax |
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Provider Business Mailing Address
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Address Line | 15725 SE UPMAN WAY
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City | DAMASCUS
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State | OR
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Zip | 97089-6851
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Country | US
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Telephone | 503-764-7042
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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 | 14097
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License Number State | OR
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