Individual
MR. MARK CLEGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2031 E BURNSIDE ST, PORTLAND, OR 97214-1649
(503) 224-2100
(503) 224-2129
Mailing address
3200 SE 21ST AVE, PORTLAND, OR 97202-2318
(503) 516-3160
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6717
OR
Other
Enumeration date
04/13/2007
Last updated
03/13/2009
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