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General NPI Number Information
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NPI Number | 1689087041
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Entity Type | Individual
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Provider Name | ELIZA WERTH-DAVIS LMT
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Gender | Female
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 16083 SW UPPER BOONES FERRY RD STE 300
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City | TIGARD
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State | OR
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Zip | 97224-7736
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Country | US
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Telephone | 800-219-8835
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Fax | 503-639-9699
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Provider Business Mailing Address
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Address Line | 17355 BOONES FERRY RD SUITE B
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-5202
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Country | US
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Telephone | 503-635-0844
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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 | 20653
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License Number State | OR
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