Individual
MISTY L MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
551 LONE PINE BLVD, THE DALLES, OR 97058-9403
(541) 506-5779
Mailing address
693 DRY CREEK RD, MOSIER, OR 97040-9772
(530) 260-0995
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
COS-FT-10118887
OR
Other
Enumeration date
07/05/2018
Last updated
11/13/2018
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