Individual
MRS. MYLISA ANNE ERVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
836 ADAMS LOOP, HOOD RIVER, OR 97031-9743
(503) 319-4785
Mailing address
836 ADAMS LOOP, HOOD RIVER, OR 97031-9743
(503) 319-4785
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
7101
OR
172M00000X
Mechanotherapist
MA00013019
WA
Other
Enumeration date
04/10/2007
Last updated
08/30/2007
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