Individual
JASON MAYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
4445 SW BARBUR BLVD, SUITE 104, PORTLAND, OR 97239-4047
(503) 226-4500
(503) 226-0796
Mailing address
14175 SW SPINNAKER DR, BEAVERTON, OR 97005-3656
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
11108
OR
Other
Enumeration date
09/15/2009
Last updated
09/15/2009
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