Individual
DELISA VAN DYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
940 SE LOCUST ST, DUNDEE, OR 97115-9630
(503) 915-6022
Mailing address
940 SE LOCUST ST, DUNDEE, OR 97115-9630
(503) 915-6022
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17096
OR
Other
Enumeration date
09/10/2014
Last updated
09/23/2014
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