Provider Demographics
NPI:1427223262
Name:PEREVERZINA, NADEJDA (LMT)
Entity type:Individual
Prefix:
First Name:NADEJDA
Middle Name:
Last Name:PEREVERZINA
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 1:3910 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7174
Mailing Address - Country:US
Mailing Address - Phone:503-674-5404
Mailing Address - Fax:
Practice Address - Street 1:3910 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-7174
Practice Address - Country:US
Practice Address - Phone:503-674-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10460225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist