Individual
EARL TEMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
6504 NE SISKIYOU ST, PORTLAND, OR 97213-4572
(503) 327-3819
Mailing address
523 NE 69TH AVE, PORTLAND, OR 97213-5529
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25101
OR
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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