Provider Demographics
NPI:1285107292
Name:REBECCA MINIFIE, LMT, LLC
Entity type:Organization
Organization Name:REBECCA MINIFIE, LMT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINIFIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-758-8474
Mailing Address - Street 1:108 S COLLEGE ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3110
Mailing Address - Country:US
Mailing Address - Phone:503-758-8474
Mailing Address - Fax:503-419-9873
Practice Address - Street 1:108 S COLLEGE ST STE B
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3110
Practice Address - Country:US
Practice Address - Phone:503-758-8474
Practice Address - Fax:503-419-9873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty