MEDICARE: MR. ERIK NEIL CANNARD 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	14672	OR

General Provider Information

NPI Number	:	1881954394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIK NEIL CANNARD LMT

Provider Business Mailing Address
First Line	:	10157 N ZIEGLER AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-1178
Country	:	US
Telephone Number	:	503-544-7540
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 N KILLINGSWORTH ST STE 205
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-2440
Country	:	US
Telephone Number	:	503-544-7540
Fax Number	:

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

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	02/07/2025

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