MEDICARE: LISA DAWN CALVIN

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	28810	OR

General Provider Information

NPI Number	:	1619774353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA DAWN CALVIN

Provider Business Mailing Address
First Line	:	1334 N ALBERTA ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-3704
Country	:	US
Telephone Number	:	503-709-0109
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 N SUMNER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-3742
Country	:	US
Telephone Number	:	503-709-0109
Fax Number	:

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

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	02/28/2025

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Directions to “ LISA DAWN CALVIN ” Practice Location

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