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NPI Code Detail

MEDICARE: AMY NICOLE WEDDLE LMT

MEDICARE: AMY NICOLE WEDDLE LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist13880OR

General Provider Information

NPI Number : 1043425655
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY NICOLE WEDDLE LMT
Provider Business Mailing Address
First Line : 4930 SW 1ST AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-2883
Country : US
Telephone Number : 503-545-1066
Fax Number :
Provider Business Practice Location Address
First Line : 4425 SW CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4260
Country : US
Telephone Number : 503-225-9033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/08/2007

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Directions to “ AMY NICOLE WEDDLE LMT” Practice Location

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