Provider Demographics
NPI:1063870285
Name:ROBERTS, DALYNN
Entity type:Individual
Prefix:
First Name:DALYNN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23585 NW JACOBSON RD
Mailing Address - Street 2:#38
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9302
Mailing Address - Country:US
Mailing Address - Phone:509-654-3320
Mailing Address - Fax:
Practice Address - Street 1:4655 SW GRIFFITH DR
Practice Address - Street 2:#180
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-8728
Practice Address - Country:US
Practice Address - Phone:503-746-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-19790225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist