Provider Demographics
NPI:1104285154
Name:FREITAG, RICHARD (LMT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FREITAG
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13452 NE SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2628
Mailing Address - Country:US
Mailing Address - Phone:503-334-8695
Mailing Address - Fax:
Practice Address - Street 1:1359 NE 35TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1941
Practice Address - Country:US
Practice Address - Phone:503-389-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22055225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist