Provider Demographics
NPI:1871026161
Name:COX, THERESA M (LMT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:COX
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 1:1357 NE SHARKEY TER
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6040
Mailing Address - Country:US
Mailing Address - Phone:541-281-7017
Mailing Address - Fax:
Practice Address - Street 1:716 SW HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-3120
Practice Address - Country:US
Practice Address - Phone:541-516-1045
Practice Address - Fax:541-516-1047
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15956172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15956OtherLICENSED MASSAGE THERAPIST