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General NPI Number Information
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NPI Number | 1649694456
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Entity Type | Individual
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Provider Name | EVA ROSE LUTZ L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 114 E HANCOCK ST
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City | NEWBERG
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State | OR
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Zip | 97132-2822
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Country | US
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Telephone | 503-554-0661
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Fax | 503-554-9126
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Provider Business Mailing Address
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Address Line | 608 E FOOTHILLS DR
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City | NEWBERG
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State | OR
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Zip | 97132-9014
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Country | US
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Telephone | 503-857-5563
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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 | 17503
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License Number State | OR
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