Individual
WALTER LIBBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1695 JEFFERSON ST, EUGENE, OR 97402-4063
(541) 344-9700
Mailing address
1695 JEFFERSON ST, EUGENE, OR 97402-4063
(541) 344-9700
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
5122
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5122
MASSAGE THERAPIST
—
Enumeration date
11/09/2007
Last updated
11/09/2007
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