Individual
MIZUKO TAKAMOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3200 JUANIPERO WAY, MEDFORD, OR 97504-8580
(541) 816-4131
(458) 226-2163
Mailing address
PO BOX 12096, DES MOINES, IA 50312-9402
(515) 414-9339
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26563
OR
Other
Enumeration date
01/24/2022
Last updated
09/14/2023
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