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General NPI Number Information
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NPI Number | 1407176902
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Entity Type | Individual
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Provider Name | LORI REISING LMT
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Gender | Female
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 3531 NE 15TH AVE SUITE A
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City | PORTLAND
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State | OR
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Zip | 97212-2377
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Country | US
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Telephone | 503-287-0886
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Fax |
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Provider Business Mailing Address
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Address Line | 6516 SE HAROLD ST
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City | PORTLAND
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State | OR
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Zip | 97206-5439
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Country | US
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Telephone | 515-320-4071
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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 | 7680
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License Number State | OR
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