MEDICARE: MS. LINDA LEE PHELAN 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	225700000X	Massage Therapist	1023	OR

General Provider Information

NPI Number	:	1538387709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA LEE PHELAN LMT

Provider Business Mailing Address
First Line	:	9735 SW SHADY LN
Second Line	:	SUITE 103
City	:	TIGARD
State	:	OR
Zip	:	97223-5481
Country	:	US
Telephone Number	:	503-684-1273
Fax Number	:

Provider Business Practice Location Address
First Line	:	9735 SW SHADY LN
Second Line	:	SUITE 103
City	:	TIGARD
State	:	OR
Zip	:	97223-5481
Country	:	US
Telephone Number	:	503-684-1273
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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