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General NPI Number Information
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NPI Number | 1801636162
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Entity Type | Individual
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Provider Name | IVA DUBYAK LMT
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Gender | Female
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Dates
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Enumeration Date | 05/25/2024
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Last Update Date | 05/25/2024
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Provider Practice Location Address
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Address Line | 2933 NE BROADWAY ST
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City | PORTLAND
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State | OR
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Zip | 97232-1760
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Country | US
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Telephone | 503-960-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 7902 SE MITCHELL ST
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City | PORTLAND
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State | OR
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Zip | 97206-4252
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Country | US
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Telephone | 510-706-1633
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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 | 27924
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License Number State | OR
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