Organization
DEEP GROUND MASSAGE & BODYWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE LAVON TROTTER LMT (OWNER)
(503) 926-4045
Entity
Organization
Contact information
Practice address
1725 SE HAWTHORNE BLVD, PORTLAND, OR 97214-3722
(503) 926-4045
Mailing address
4935 SE 74TH AVE, PORTLAND, OR 97206-4339
(503) 926-4045
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18138
OR
Other
Enumeration date
08/11/2016
Last updated
08/11/2016
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