Individual
JASON ISHMAEL EZZY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, AHS
Contact information
Practice address
1717 CONGRESS ST STE 3, PORTLAND, ME 04102-1983
(207) 449-2847
Mailing address
365 MAIN ST APT 102, BIDDEFORD, ME 04005-6304
(207) 449-2847
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT4860
ME
Other
Enumeration date
10/13/2021
Last updated
10/13/2021
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