Individual
MITCH LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
320 SW 2ND ST, CORVALLIS, OR 97333-4632
(541) 602-2289
Mailing address
320 SW 2ND ST, CORVALLIS, OR 97333-4632
(541) 602-2289
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22284
OR
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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