=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679478614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LMT LAURA PDX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2026
-----------------------------------------------------
Last Update Date | 10/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23216 SW DARBY AVE
-----------------------------------------------------
City | TUALATIN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97062-7656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-729-1838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23216 SW DARBY AVE
-----------------------------------------------------
City | TUALATIN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97062-7656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-729-1838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LMT
-----------------------------------------------------
Name | LAURA A PIERCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 503-729-1838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------