Individual
MR. NICHOLAS JOHNSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
21860 WILLAMETTE DR, WEST LINN, OR 97068-3256
(503) 650-2394
Mailing address
7035 SW 15TH AVE, PORTLAND, OR 97219-2032
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20214
OR
Other
Enumeration date
01/03/2014
Last updated
01/03/2014
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