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General NPI Number Information
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NPI Number | 1396667788
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Entity Type | Individual
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Provider Name | MAXON RYAN GRIFFIN
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Gender | Male
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 929 SW SIMPSON AVE STE 140
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City | BEND
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State | OR
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Zip | 97702-3599
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Country | US
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Telephone | 541-617-9771
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Fax |
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Provider Business Mailing Address
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Address Line | 717 NW GEORGIA AVE UNIT 3
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City | BEND
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State | OR
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Zip | 97703-3261
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Country | US
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Telephone | 541-948-7208
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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 | 29788
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License Number State | OR
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