Provider Demographics
NPI:1396458535
Name:VIEHDORFER, GARY W (LMT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:VIEHDORFER
Suffix:
Gender:M
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:PO BOX 4374
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-8374
Mailing Address - Country:US
Mailing Address - Phone:503-480-9674
Mailing Address - Fax:
Practice Address - Street 1:3957 SHANIKO CT SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1717
Practice Address - Country:US
Practice Address - Phone:503-480-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11376225700000X
OR14894225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist