Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 10525 | OR |
NPI | 1023131000 |
---|---|
Provider Name | Timohty P Haster |
First Address | Portland, OR 97206-8373 |
Second Address | Portland, OR 97209-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 25/03/2009 |