Provider Demographics
NPI:1194411280
Name:FOLKMAN, SPENCER (LMT)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:FOLKMAN
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 1:12375 SW SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5276
Mailing Address - Country:US
Mailing Address - Phone:503-808-0441
Mailing Address - Fax:
Practice Address - Street 1:29702 SW TOWN CENTER LOOP W STE C
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6481
Practice Address - Country:US
Practice Address - Phone:503-583-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27626225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist