Provider Demographics
NPI:1215320932
Name:YOKUM, DANA (LMT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:YOKUM
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 1:3808 N WILLIAMS AVE
Mailing Address - Street 2:#133
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1467
Mailing Address - Country:US
Mailing Address - Phone:503-445-1188
Mailing Address - Fax:503-445-1189
Practice Address - Street 1:3808 N WILLIAMS AVE
Practice Address - Street 2:#133
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1467
Practice Address - Country:US
Practice Address - Phone:503-445-1188
Practice Address - Fax:503-445-1189
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist