Organization
EDGE PERFORMANCE FITNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM AMADON (GENERAL MANAGER)
(503) 265-8685
Entity
Organization
Contact information
Practice address
1502 N AINSWORTH ST, PORTLAND, OR 97217-4706
(503) 265-8685
Mailing address
1502 N AINSWORTH ST, PORTLAND, OR 97217-4706
(503) 265-8685
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16562
OR
Other
Enumeration date
04/13/2010
Last updated
04/13/2010
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