MEDICARE: DANIEL FLYNN 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	17054	OR

General Provider Information

NPI Number	:	1952600280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL FLYNN LMT

Provider Business Mailing Address
First Line	:	5533 NE 30TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-6805
Country	:	US
Telephone Number	:	503-764-5080
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 NE 20TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3094
Country	:	US
Telephone Number	:	503-764-5080
Fax Number	:

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

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	05/08/2013

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