Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 10357 | OR |
N | 226300000X | Kinesiotherapist |
NPI | 1437476173 |
---|---|
Provider Name | Casey Naimat Cardoso |
First Address | Portland, OR 97212-0054 |
Second Address | Portland, OR 97212-3978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2010 |
Last Update Date | 04/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10357 | OREGON BOARD OF MASSAGE THERAPISTS (01) | OR |
776898 | AMERICA COLLEGE OF SPORTS MEDICINE (01) |