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General NPI Number Information
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NPI Number | 1730592031
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Entity Type | Individual
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Provider Name | JEAN GERBRACHT LMT
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Gender | Female
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 5215 NE ELAM YOUNG PKWY STE A
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City | HILLSBORO
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State | OR
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Zip | 97124-6498
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Country | US
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Telephone | 503-693-9101
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Fax | 503-693-9123
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Provider Business Mailing Address
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Address Line | 21745 SW LOIS ST
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City | ALOHA
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State | OR
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Zip | 97006-7022
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Country | US
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Telephone | 503-936-8474
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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 | 17268
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License Number State | OR
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