Organization
CANOPY CLINIC PDX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY FORESTER (LMT)
(971) 266-3796
Entity
Organization
Contact information
Practice address
917 SW OAK ST STE 406, PORTLAND, OR 97205-2838
(971) 266-3796
Mailing address
1937 NW JOHNSON ST APT 4, PORTLAND, OR 97209-1335
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
—
—
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
06/01/2022
Last updated
01/21/2025
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