Individual
BRIAN SODERHOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
22400 SE STARK ST, GRESHAM, OR 97030-2656
(503) 491-5555
(503) 674-5005
Mailing address
3536 N COMMERCIAL AVE, PORTLAND, OR 97227-1308
(773) 701-0675
(503) 674-5005
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
18501
OR
225700000X
Massage Therapist
18501
OR
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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