Provider Demographics
NPI:1730624149
Name:MENASCHE, LEYLA (LMT)
Entity type:Individual
Prefix:
First Name:LEYLA
Middle Name:
Last Name:MENASCHE
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 1:920 NW KEARNEY ST
Mailing Address - Street 2:APT 140
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3426
Mailing Address - Country:US
Mailing Address - Phone:503-307-0779
Mailing Address - Fax:
Practice Address - Street 1:9828 E BURNSIDE ST
Practice Address - Street 2:STE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2354
Practice Address - Country:US
Practice Address - Phone:503-254-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13468225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist