Provider Demographics
NPI:1194272153
Name:TUFFIAS, MICHELLE RENEE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:TUFFIAS
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 1:914 SW 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2001
Mailing Address - Country:US
Mailing Address - Phone:503-765-5333
Mailing Address - Fax:
Practice Address - Street 1:914 SW 11TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2001
Practice Address - Country:US
Practice Address - Phone:503-765-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20529225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist