Individual
LYDIA BLAIR VAIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5517 N COMMERCIAL AVE, PORTLAND, OR 97217-2339
(971) 404-7147
Mailing address
5517 N COMMERCIAL AVE, PORTLAND, OR 97217-2339
(971) 404-7147
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12753
OR
Other
Enumeration date
08/21/2007
Last updated
08/21/2007
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