Individual
KORINNE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
405 NE DIVISION ST, GRESHAM, OR 97030-3947
(503) 661-0791
Mailing address
923 NE 55TH AVE, PORTLAND, OR 97213-3604
(414) 484-8222
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25020
OR
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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