Individual
JONATHAN HETRICK WOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5263 NE 16TH AVE, PORTLAND, OR 97211-4423
(503) 915-9835
Mailing address
5263 NE 16TH AVE, PORTLAND, OR 97211-4423
(503) 915-9835
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20541
OR
Other
Enumeration date
12/01/2016
Last updated
05/14/2020
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