Provider Demographics
NPI:1679306179
Name:PANKLIB, NITHINUNT (LMT)
Entity type:Individual
Prefix:
First Name:NITHINUNT
Middle Name:
Last Name:PANKLIB
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 1:7718 SW 45TH AVE APT 55
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1552
Mailing Address - Country:US
Mailing Address - Phone:941-264-6122
Mailing Address - Fax:
Practice Address - Street 1:7718 SW 45TH AVE APT 55
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1552
Practice Address - Country:US
Practice Address - Phone:941-264-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR29211225700000X
FLM78570225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist