Provider Demographics
NPI:1144477993
Name:DORSEY, RAYNA E (LMT, LMP)
Entity type:Individual
Prefix:
First Name:RAYNA
Middle Name:E
Last Name:DORSEY
Suffix:
Gender:F
Credentials:LMT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 NE 42ND AVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1569
Mailing Address - Country:US
Mailing Address - Phone:503-249-2824
Mailing Address - Fax:
Practice Address - Street 1:1717 NE 42ND AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1569
Practice Address - Country:US
Practice Address - Phone:503-249-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist