=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740476266
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RASA WILLIS LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2007
-----------------------------------------------------
Last Update Date | 09/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7417 SW BEAVERTON HILLSDALE HWY SUIT 200
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97225-2169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-291-7155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11589 SW DAVIES RD APT 3002
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97007-8327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-380-0176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 13182
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------