Individual
LYLE DETTLOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
728 NE DEKUM ST, PORTLAND, OR 97211-3628
(503) 568-1906
Mailing address
728 NE DEKUM ST, PORTLAND, OR 97211-3628
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
04/24/2019
Last updated
04/24/2019
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