MEDICARE: LORIN GREEN LMP

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

General Provider Information

NPI Number	:	1629593397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIN GREEN LMP

Provider Business Mailing Address
First Line	:	118 N LIBERTY ST APT A
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-4322
Country	:	US
Telephone Number	:	360-457-7379
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 N LIBERTY ST APT A
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-4322
Country	:	US
Telephone Number	:	360-457-7379
Fax Number	:

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

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	07/21/2022

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Directions to “ LORIN GREEN LMP” Practice Location

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