Provider Demographics
NPI:1326218181
Name:NELSON, RUE HETHER (LMT)
Entity type:Individual
Prefix:
First Name:RUE
Middle Name:HETHER
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:RUE
Other - Middle Name:HETHER
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:560 NE F ST
Mailing Address - Street 2:STE A PMB 459
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-5124
Mailing Address - Country:US
Mailing Address - Phone:458-229-0304
Mailing Address - Fax:
Practice Address - Street 1:2375 LOWER RIVER RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-9020
Practice Address - Country:US
Practice Address - Phone:458-229-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR12191OtherSTATE OF OR BOARD OF MASSAGE THERAPISTS