Individual
DALTON BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
14619 SW TEAL BLVD, BEAVERTON, OR 97007-6194
(503) 746-6585
Mailing address
534 ILLINOIS AVE NE, SALEM, OR 97301-4632
(503) 991-2154
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19467
OR
Other
Enumeration date
04/14/2014
Last updated
04/14/2014
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