Provider Demographics
NPI:1609108992
Name:GASPORRA, DAVID ALEXANDER (LMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:GASPORRA
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 1:1104 SW COLUMBIA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3498
Mailing Address - Country:US
Mailing Address - Phone:503-224-8623
Mailing Address - Fax:
Practice Address - Street 1:1104 SW COLUMBIA ST STE 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3498
Practice Address - Country:US
Practice Address - Phone:503-224-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6498225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist