Provider Demographics
NPI:1154140259
Name:ADAMIEC, GRAZYNA (LMT)
Entity type:Individual
Prefix:
First Name:GRAZYNA
Middle Name:
Last Name:ADAMIEC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:ADAMIEC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:210 NE 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3830
Mailing Address - Country:US
Mailing Address - Phone:312-662-9349
Mailing Address - Fax:
Practice Address - Street 1:5939 SE BELMONT ST UNIT A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1994
Practice Address - Country:US
Practice Address - Phone:503-231-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty