Provider Demographics
NPI:1205250024
Name:PLEASANT, KYLE (LMT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:PLEASANT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 NW NAITO PKWY
Mailing Address - Street 2:APT 314
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-4705
Mailing Address - Country:US
Mailing Address - Phone:903-245-0512
Mailing Address - Fax:
Practice Address - Street 1:718 SW ALDER ST
Practice Address - Street 2:SUITE 218
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3422
Practice Address - Country:US
Practice Address - Phone:903-245-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20302225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist