Individual
BENJAMIN LAKIN KOENIGSBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2928 SE HAWTHORNE BLVD, #101, PORTLAND, OR 97214-4147
(503) 358-5187
Mailing address
3922 SE 49TH AVE, PORTLAND, OR 97206-3018
(503) 358-5187
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18009
OR
Other
Enumeration date
12/26/2012
Last updated
12/26/2012
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