Organization
BLUEPRINT FOR BALANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. COLLAINE BROOKE FADDIS LMT (LICENSED MASSAGE THERAPIST)
(503) 810-4941
Entity
Organization
Contact information
Practice address
7 SE 30TH AVE, PORTLAND, OR 97214-1902
(503) 810-4941
Mailing address
7 SE 30TH AVE, PORTLAND, OR 97214-1902
(503) 810-4941
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
14317
OR
Other
Enumeration date
04/12/2012
Last updated
04/12/2012
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