Individual
MR. JONATHAN CLARK GROSSART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, CERT ADV ROLFER
Contact information
Practice address
1727 NE 13TH AVE STE 101, PORTLAND, OR 97212-4378
(503) 933-8066
Mailing address
1727 NE 13TH AVE STE 101, PORTLAND, OR 97212-4378
(503) 933-8066
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13752
OR
Other
Enumeration date
12/04/2008
Last updated
11/01/2017
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