Individual
KRISTINA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4632 SE BOISE ST, PORTLAND, OR 97206-4040
(503) 577-7890
Mailing address
4632 SE BOISE ST, PORTLAND, OR 97206-4040
(503) 577-7890
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22576
OR
Other
Enumeration date
08/23/2016
Last updated
08/23/2016
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