Individual
AMANDA GANGSTEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13306 NW CORNELL RD STE 207, PORTLAND, OR 97229-5806
(541) 749-0818
Mailing address
16312 SW ESTUARY DR APT 203, BEAVERTON, OR 97006-7936
(541) 749-0818
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18143
OR
Other
Enumeration date
02/03/2019
Last updated
02/03/2019
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