Individual
LAWRENCE AUSTIN BIRCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1215 MAIN STREET, STE 106, PHILOMATH, OR 97370
(541) 344-7534
Mailing address
1590 COUGAR CT SW, ALBANY, OR 97321-4878
(541) 344-7534
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19963
OR
Other
Enumeration date
04/23/2014
Last updated
04/23/2014
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