Organization
CONCETTA M ANTONELLI LMT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CONCETTA MARIE ANTONELLI LMT (MASSAGE THERAPIST)
(503) 349-7038
Entity
Organization
Contact information
Practice address
311 B AVE, STE L, LAKE OSWEGO, OR 97034-3011
(503) 349-7038
Mailing address
11375 SE 33RD AVE, MILWAUKIE, OR 97222-6754
(503) 349-7038
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7449
OR
Other
Enumeration date
12/26/2012
Last updated
12/26/2012
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