Individual
MISTY FALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1016 SE 12TH AVE, PORTLAND, OR 97214-2513
(971) 303-9557
Mailing address
4912 NE 32ND AVE, PORTLAND, OR 97211-7024
(503) 875-4897
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23135
OR
Other
Enumeration date
07/24/2017
Last updated
07/24/2017
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