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Organization
SPA WILLAMINA
Active
Organization
SPA WILLAMINA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLOW LIGHT (OWNER)
(503) 287-2787
Entity
Organization
Contact information
Practice address
1928 NE 40TH AVE., PORTLAND, OR 97212
(503) 287-2787
Mailing address
1928 NE 40TH AVE., PORTLAND, OR 97212
(503) 287-2787
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
11/09/2010
Last updated
11/09/2010
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