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NPI Code Detail

MEDICARE: CALLIE ALBERTUS

MEDICARE: CALLIE ALBERTUS
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
1225700000XMassage Therapist15847OR

General Provider Information

NPI Number : 1679082622
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALLIE ALBERTUS
Provider Business Mailing Address
First Line : 10021 NW 307TH AVE
Second Line :
City : NORTH PLAINS
State : OR
Zip : 97133-7109
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16679 BOONES FERRY RD STE 105
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-4378
Country : US
Telephone Number : 503-635-6005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2017
Last Update Date : 09/21/2017

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Directions to “ CALLIE ALBERTUS ” Practice Location

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