Provider Demographics
NPI:1316241029
Name:PICKLE, BARBARA ANN (LMT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:PICKLE
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 1:3950 SW 102ND AVE APT 96
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4674
Mailing Address - Country:US
Mailing Address - Phone:503-332-0454
Mailing Address - Fax:
Practice Address - Street 1:10211 SW BARBUR BLVD STE 206A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5935
Practice Address - Country:US
Practice Address - Phone:503-332-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11011172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist