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Organization
REVIVANATION LLC
Active
Organization
REVIVANATION LLC
Active
Other names
eyem
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN M BURBANK LMT (OWNER/THERAPIST)
(503) 765-5333
Entity
Organization
Contact information
Practice address
914 SW 11TH AVE, PORTLAND, OR 97205-2001
(503) 765-5333
(888) 495-4549
Mailing address
914 SW 11TH AVE, PORTLAND, OR 97205-2001
(503) 765-5333
(888) 495-4549
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AC01286
OR
225700000X
Massage Therapist
13830
OR
225700000X
Massage Therapist
Primary
17523
OR
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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