Provider Demographics
NPI:1194294199
Name:CRETEN, JOACHIM (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:JOACHIM
Middle Name:
Last Name:CRETEN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 NW GLISAN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3054
Mailing Address - Country:US
Mailing Address - Phone:503-515-1023
Mailing Address - Fax:
Practice Address - Street 1:1211 NW GLISAN ST STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3054
Practice Address - Country:US
Practice Address - Phone:503-515-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist