Individual
NATHAN ISAIAH PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
2390 NW THURMAN ST, PORTLAND, OR 97210-2521
(541) 543-3512
Mailing address
6530 SE 63RD AVE, PORTLAND, OR 97206-7402
(541) 543-3512
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21438
OR
Other
Enumeration date
06/28/2016
Last updated
06/28/2016
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