Provider Demographics
NPI:1063782092
Name:BONTERRE, ESPREE ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:ESPREE
Middle Name:ELIZABETH
Last Name:BONTERRE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 SE TACOMA ST # 347
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6639
Mailing Address - Country:US
Mailing Address - Phone:503-927-4156
Mailing Address - Fax:503-597-5464
Practice Address - Street 1:3849 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2049
Practice Address - Country:US
Practice Address - Phone:503-574-3525
Practice Address - Fax:503-597-5464
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18293225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist