MEDICARE: RAWLE ALLEN MORRIS 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	3470	OR

General Provider Information

NPI Number	:	1912107442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAWLE ALLEN MORRIS LMT

Provider Business Mailing Address
First Line	:	11000 SW BARBUR BLVD STE 201
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-8691
Country	:	US
Telephone Number	:	503-977-5171
Fax Number	:	503-997-5172

Provider Business Practice Location Address
First Line	:	11000 SW BARBUR BLVD STE 201
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-8691
Country	:	US
Telephone Number	:	503-977-5171
Fax Number	:	503-997-5172

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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