Individual
DEA LIISA CANARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7052 SW NYBERG ST, TUALATIN, OR 97062-9231
(503) 691-7788
Mailing address
7052 SW NYBERG ST, TUALATIN, OR 97062-9231
(503) 691-7788
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14025
OR
Other
Enumeration date
01/23/2008
Last updated
01/23/2008
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