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NPI Code Detail

MEDICARE: SAMANTHA LEE SERPA LMT

MEDICARE: SAMANTHA LEE SERPA 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 Therapist19489OR

General Provider Information

NPI Number : 1366786816
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA LEE SERPA LMT
Provider Business Mailing Address
First Line : 18852 SW BUTTERNUT ST APT A
Second Line :
City : ALOHA
State : OR
Zip : 97007-2564
Country : US
Telephone Number : 503-502-5712
Fax Number :
Provider Business Practice Location Address
First Line : 938 SE OAK ST
Second Line :
City : HILLSBORO
State : OR
Zip : 97123-4214
Country : US
Telephone Number : 503-352-9167
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2012
Last Update Date : 11/22/2012

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