Organization
CLASSIC BODY RESTORATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE MASSEY (OWNER)
(503) 239-2639
Entity
Organization
Contact information
Practice address
107 SE WASHINGTON ST, #125, PORTLAND, OR 97214-2103
(503) 239-2639
Mailing address
107 SE WASHINGTON ST, #125, PORTLAND, OR 97214-2103
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13098
OR
Other
Enumeration date
05/17/2012
Last updated
05/17/2012
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