Provider Demographics
NPI:1942454665
Name:D'ALONZO, NICHOLAS LAWRENCE (LMT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LAWRENCE
Last Name:D'ALONZO
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 1:5904 SE WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2678
Mailing Address - Country:US
Mailing Address - Phone:503-654-4379
Mailing Address - Fax:
Practice Address - Street 1:16097 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-4679
Practice Address - Country:US
Practice Address - Phone:503-607-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13868172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist