Individual
KUNDALINI ROSE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3100 SE ALDER CT, PORTLAND, OR 97214-3039
(503) 877-3688
Mailing address
3100 SE ALDER CT, PORTLAND, OR 97214-3039
(503) 877-3688
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14081
OR
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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