Provider Demographics
NPI:1053719823
Name:WEISS, CHRISTOPHER (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2151 NE WASCO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1618
Mailing Address - Country:US
Mailing Address - Phone:417-773-6144
Mailing Address - Fax:
Practice Address - Street 1:4424 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2331
Practice Address - Country:US
Practice Address - Phone:503-473-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT#20966225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist