Provider Demographics
NPI:1386870756
Name:FOBERT, KATHERINE ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:FOBERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8070 SW HALL BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008
Mailing Address - Country:US
Mailing Address - Phone:503-643-0156
Mailing Address - Fax:971-732-5624
Practice Address - Street 1:8070 SW HALL BLVD
Practice Address - Street 2:STE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008
Practice Address - Country:US
Practice Address - Phone:503-643-0156
Practice Address - Fax:971-732-5624
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2013-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR14614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist