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General NPI Number Information
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NPI Number | 1851431167
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Entity Type | Individual
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Provider Name | JUSTIN CANFIELD LMT
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5935 WILLOW LN
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-5344
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Country | US
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Telephone | 503-655-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 12653 SW METTA TER
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City | TIGARD
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State | OR
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Zip | 97223-5737
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Country | US
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Telephone | 503-313-0430
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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 | 12411
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License Number State | OR
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