Individual
MR. MOON MARCELLE BUKAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
501 NE GREEN WOOD AVE, 300, BEND, OR 97701
(541) 706-0961
Mailing address
501 NE GREENWOOD AVE #300, BEND, OR 97701
(541) 706-0961
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023245
OR
Other
Enumeration date
09/21/2020
Last updated
02/22/2024
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