Individual
CHARLES NICHOLAS PORTLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
LMT
Contact information
Practice address
2627 NE MARTIN LUTHER KING JR BLVD, PORTLAND, OR 97212-3758
(503) 493-9398
Mailing address
301 SW LINCOLN ST APT 606, PORTLAND, OR 97201-5029
(206) 399-5936
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT26373
OR
Other
Enumeration date
09/16/2025
Last updated
09/16/2025
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