Provider Demographics
NPI:1669593299
Name:ARMSTRONG, SALLY JO (LMT, CA, NCTMB)
Entity type:Individual
Prefix:MS
First Name:SALLY JO
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:LMT, CA, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97075-0185
Mailing Address - Country:US
Mailing Address - Phone:503-225-9033
Mailing Address - Fax:503-225-9039
Practice Address - Street 1:4425 SW CORBETT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4260
Practice Address - Country:US
Practice Address - Phone:503-225-9033
Practice Address - Fax:503-225-9039
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#O6234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR97124OtherMULTIPLE INS. #'S