Individual
COREY BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2442 SE 101ST AVE STE 308, PORTLAND, OR 97216-3065
(971) 678-6663
Mailing address
5130 SE 72ND AVE, PORTLAND, OR 97206-4400
(971) 678-6663
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
28443
OR
Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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