Individual
MRS. DEVON MARIE BRUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
289 E ELLENDALE AVE STE 101, DALLAS, OR 97338-1500
(503) 623-9676
Mailing address
1300 NW ADAMS ST. UNIT C, MCMINNVILLE, OR 97128
(971) 237-5901
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22789
OR
Other
Enumeration date
09/17/2018
Last updated
09/25/2019
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