MEDICARE: CARRIE MARIE STRUSS 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	18232	OR

General Provider Information

NPI Number	:	1649549171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE MARIE STRUSS LMT

Provider Business Mailing Address
First Line	:	3236 NE ALBERTA ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7064
Country	:	US
Telephone Number	:	503-953-0850
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 NE FREMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-2453
Country	:	US
Telephone Number	:	503-953-0850
Fax Number	:

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

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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