Organization
BEAVERTON MEDICAL MASSAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KC DAVIDSON LMT (OWNER)
(503) 730-0884
Entity
Organization
Contact information
Practice address
3863 SW HALL BLVD STE B, BEAVERTON, OR 97005-2042
(503) 730-0884
Mailing address
3863 SW HALL BLVD STE B, BEAVERTON, OR 97005-2042
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7107
OR
Other
Enumeration date
05/25/2016
Last updated
05/25/2016
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