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NPI Code Detail

MEDICARE: TERRILL LANA VANCE LMT

MEDICARE: TERRILL LANA VANCE 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 Therapist18814OR

General Provider Information

NPI Number : 1376475657
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRILL LANA VANCE LMT
Provider Business Mailing Address
First Line : 2149 NE BROADWAY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-1580
Country : US
Telephone Number : 503-281-0278
Fax Number : 503-284-6182
Provider Business Practice Location Address
First Line : 2149 NE BROADWAY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-1580
Country : US
Telephone Number : 503-281-0278
Fax Number : 503-284-6182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ TERRILL LANA VANCE LMT” Practice Location

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