Individual
KEVIN THOMAS RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2220 NW FRONT AVE APT 316, PORTLAND, OR 97209-1998
(360) 621-2920
Mailing address
2220 NW FRONT AVE APT 316, PORTLAND, OR 97209-1998
(360) 621-2920
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25054
OR
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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