MEDICARE: ANDREA SOPHIA PINHEIRO

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	225800000X	Recreation Therapist	290011	LA
2	225700000X	Massage Therapist	20181	OR

General Provider Information

NPI Number	:	1174911473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SOPHIA PINHEIRO

Provider Business Mailing Address
First Line	:	15284 SW ROYALTY PKWY APT C01
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97224-3993
Country	:	US
Telephone Number	:	305-713-4016
Fax Number	:

Provider Business Practice Location Address
First Line	:	7428 N CHARLESTON AVE APT 434
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-3782
Country	:	US
Telephone Number	:	305-713-4016
Fax Number	:

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

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	07/21/2020

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Directions to “ ANDREA SOPHIA PINHEIRO ” Practice Location

Language	Start Address	Practice Location

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