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General NPI Number Information
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NPI Number | 1437546298
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Entity Type | Individual
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Provider Name | MR. MICHAEL THOMAS REXFORD JR.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 10/27/2024
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Provider Practice Location Address
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Address Line | 1355 NW EVERETT ST STE 100
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City | PORTLAND
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State | OR
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Zip | 97209-2655
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Country | US
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Telephone | 971-433-5334
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Fax | 971-200-8669
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Provider Business Mailing Address
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Address Line | 1355 NW EVERETT ST STE 100
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City | PORTLAND
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State | OR
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Zip | 97209-2655
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Country | US
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Telephone | 971-433-5334
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Fax | 971-200-8669
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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 | 8875609-4701
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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