Provider Demographics
NPI:1194964627
Name:WOODS, ERIC BRIAN (LMT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:BRIAN
Last Name:WOODS
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 1:1911 MOUNTAIN VIEW LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2382
Mailing Address - Country:US
Mailing Address - Phone:503-481-1644
Mailing Address - Fax:503-357-4831
Practice Address - Street 1:1911 MOUNTAIN VIEW LN
Practice Address - Street 2:SUITE 200
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2382
Practice Address - Country:US
Practice Address - Phone:503-481-1644
Practice Address - Fax:503-357-4831
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13034225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist