Individual
ELISA BROCKWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
530 1ST ST STE B2, LAKE OSWEGO, OR 97034-3248
(971) 344-4223
Mailing address
1605 NE 76TH AVE, PORTLAND, OR 97213-6747
(971) 344-4223
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7964
OR
Other
Enumeration date
07/14/2020
Last updated
07/14/2020
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