Individual
KRISTA NICOLE RADETICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
124 SW YAMHILL ST STE 200, PORTLAND, OR 97204-3019
(971) 409-6725
Mailing address
530 NW 23RD AVE, #403, PORTLAND, OR 97210-3275
(971) 409-6725
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16345
OR
Other
Enumeration date
07/10/2013
Last updated
07/10/2013
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