Individual
GARY LEROY WASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2929 SW MULTNOMAH BLVD STE 207, PORTLAND, OR 97219-4072
(509) 240-6989
Mailing address
2929 SW MULTNOMAH BLVD STE 207, PORTLAND, OR 97219-4072
(509) 240-6989
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00016138
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5633
OREGON STATE LISCENCE
OR
01
—
MA00016138
STATE LISCENCE NUMBER
WA
Enumeration date
05/08/2007
Last updated
12/08/2014
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