Individual
ANDREW RUSSELL VAN DER WERF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2526 NE 15TH AVE, PORTLAND, OR 97212-4222
(503) 288-7668
Mailing address
12600 SE HAROLD ST, PORTLAND, OR 97236-4225
(775) 400-6619
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23850
OR
Other
Enumeration date
03/21/2018
Last updated
03/21/2018
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