Individual
DOUGLAS LEE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
16906 SE 1ST ST STE 103, VANCOUVER, WA 98684-8512
(360) 903-9963
Mailing address
6700 NE 162ND AVE STE 611, VANCOUVER, WA 98682-3899
(360) 903-9963
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00011374
WA
Other
Enumeration date
03/31/2007
Last updated
07/21/2022
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