Provider Demographics
NPI:1043858178
Name:SWEET, DARLA (LMT)
Entity type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:
Last Name:SWEET
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 1:7550 SW 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9469
Mailing Address - Country:US
Mailing Address - Phone:503-957-3146
Mailing Address - Fax:
Practice Address - Street 1:7550 SW 66TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-9469
Practice Address - Country:US
Practice Address - Phone:503-957-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25491225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist