Individual
DANIEL LEAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1217 NE BURNSIDE RD STE 701D, GRESHAM, OR 97030-5770
(503) 348-4797
(503) 667-3403
Mailing address
1525 SE 139TH AVE, PORTLAND, OR 97233-2306
(971) 998-0966
(503) 667-3403
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20278
OR
Other
Enumeration date
12/22/2014
Last updated
12/22/2014
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