Provider Demographics
NPI:1144992199
Name:VAULTE, ERIC HOAN
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:HOAN
Last Name:VAULTE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:ANTHONY
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16255 SW AUDUBON ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-7798
Mailing Address - Country:US
Mailing Address - Phone:503-803-5814
Mailing Address - Fax:
Practice Address - Street 1:18676 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8435
Practice Address - Country:US
Practice Address - Phone:971-404-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25134225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist