Individual
MICHAEL TAIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
419 NW 23RD AVE, PORTLAND, OR 97210-3470
(415) 742-1069
Mailing address
1237 NW 23RD AVE, PORTLAND, OR 97210-2905
(415) 742-1069
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18514
OR
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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