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Organization
TRENT D. WILSON
Active
Organization
TRENT D. WILSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRENT DANIEL WILSON (LMT)
(503) 255-7000
Entity
Organization
Contact information
Practice address
8401 NE HALSEY ST., SUITE 101, PORTLAND, OR 97220
(503) 255-7000
(503) 255-7001
Mailing address
957 NE 110TH AVE, PORTLAND, OR 97220
(503) 255-7000
(503) 255-7001
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10366
OR
Other
Enumeration date
04/26/2016
Last updated
04/26/2016
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