MEDICARE: BRIAN PATRICK BARTHELEMY LAC, 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	171W00000X	Contractor	MSG002475	PA
2	225700000X	Massage Therapist	21121	OR
3	171100000X	Acupuncturist	AC186592	OR

General Provider Information

NPI Number	:	1518215888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN PATRICK BARTHELEMY LAC, LMT

Provider Business Mailing Address
First Line	:	80 SE MADISON ST STE 216
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4527
Country	:	US
Telephone Number	:	503-926-7810
Fax Number	:	503-296-2100

Provider Business Practice Location Address
First Line	:	80 SE MADISON ST STE 216
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4527
Country	:	US
Telephone Number	:	503-926-7810
Fax Number	:	503-296-2100

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

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	11/20/2019

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