Individual
GEORGIA FOUNTAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
22400 SE STARK ST, SUITE 104, GRESHAM, OR 97030-2656
(503) 491-5555
Mailing address
22400 SE STARK ST, SUITE 104, GRESHAM, OR 97030-2656
(503) 491-5555
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
1113
MD
225700000X
Massage Therapist
Primary
19041
OR
Other
Enumeration date
07/31/2012
Last updated
07/31/2012
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