MEDICARE: ZACHARY RYAN VINSON 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
1	225700000X	Massage Therapist	24240	OR

General Provider Information

NPI Number	:	1164877957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY RYAN VINSON LMT

Provider Business Mailing Address
First Line	:	8217 N WAYLAND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-3629
Country	:	US
Telephone Number	:	208-971-1688
Fax Number	:

Provider Business Practice Location Address
First Line	:	7238 N BURLINGTON AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-4817
Country	:	US
Telephone Number	:	208-971-1688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	09/04/2024

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