Individual
CONNIE BROADWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T., CA
Contact information
Practice address
585 S 7TH ST, COOS BAY, OR 97420-1301
(541) 266-7543
Mailing address
585 S 7TH ST, COOS BAY, OR 97420-1301
(541) 266-7543
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16018
OR
Other
Enumeration date
03/11/2014
Last updated
03/11/2014
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