Provider Demographics
NPI:1154757664
Name:LAURIER, ANDRE RAYMOND JR (LMT)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:RAYMOND
Last Name:LAURIER
Suffix:JR
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 1:9885 SW HALITE CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8383
Mailing Address - Country:US
Mailing Address - Phone:503-443-9096
Mailing Address - Fax:
Practice Address - Street 1:17221 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-1240
Practice Address - Country:US
Practice Address - Phone:503-760-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19218225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist