MEDICARE: MS. TERESA A GROSS 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	174400000X	Specialist	10140	OR
2	174400000X	Specialist	MA00017683	WA

General Provider Information

NPI Number	:	1215009527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA A GROSS LMT

Provider Business Mailing Address
First Line	:	4906 SW 1ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-2883
Country	:	US
Telephone Number	:	503-295-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4906 SW 1ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-2883
Country	:	US
Telephone Number	:	503-295-0600
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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Directions to “ MS. TERESA A GROSS LMT” Practice Location

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