Doctor Name: | MR. MARK DAVID DEJOHN |
NPI Number: | 1154644599 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.M.T., A.R.T. |
License Number: | 12376 |
Business Practice Address: | 2775 Nw Fairway Heights Dr Bend, OR - 977018335 |
Business Phone Number: | 5419480993 |
Business Fax Number: | |
Mailing Address: | 2775 Nw Fairway Heights Dr, BEND |
State: | OR |
Postal Code: | 977018335 |
Phone Number: | 5419480993 |
Fax Number: | |
NPI Enumeration Date: | 03/11/2010 |
NPI Last Update Date: | 03/11/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 12376 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |