Individual
MR. DERUN REN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
10626 NE GLISAN ST, PORTLAND, OR 97220-4045
(503) 896-0660
(888) 362-8689
Mailing address
10626 NE GLISAN ST, PORTLAND, OR 97220-4045
(503) 896-0660
(888) 362-8689
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15138
OR
Other
Enumeration date
05/23/2013
Last updated
05/23/2013
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