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General NPI Number Information
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NPI Number | 1942622402
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Entity Type | Individual
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Provider Name | VALENTYNA DINWIDDIE
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Gender | Female
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 15110 BOONES FERRY RD 100-C
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3468
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Country | US
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Telephone | 503-547-7103
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Fax |
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Provider Business Mailing Address
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Address Line | 25764 SW CANYON CREEK RD B204
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City | WILSONVILLE
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State | OR
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Zip | 97070-9657
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Country | US
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Telephone | 503-926-2442
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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 | 19935
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License Number State | OR
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