Individual
LARISSA HANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
56880 VENTURE LN, BEND, OR 97707-2158
(541) 241-4989
Mailing address
56880 VENTURE LN, BEND, OR 97707-2158
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023357
OR
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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