Individual
NATHAN DAVID BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
9895 SE SUNNYSIDE RD STE K, CLACKAMAS, OR 97015-9745
(503) 653-0400
Mailing address
2195 NW 18TH AVE APT 652, PORTLAND, OR 97209-2478
(503) 660-6845
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
28831
OR
Other
Enumeration date
12/06/2025
Last updated
12/06/2025
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