Individual
ANDREW ALLEN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
14511 WESTLAKE DR STE 100, LAKE OSWEGO, OR 97035-7727
(503) 598-8099
(503) 598-3980
Mailing address
6145 SW SHANNON CT, BEAVERTON, OR 97008-4668
(503) 598-8099
(503) 598-3980
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19070
OR
Other
Enumeration date
03/05/2014
Last updated
01/16/2019
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