Individual
ALYSSA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3944 N MISSISSIPPI AVE, PORTLAND, OR 97227-1163
(503) 517-8222
Mailing address
1735 SE MADISON ST APT 1, PORTLAND, OR 97214-3752
(503) 851-8717
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18673
OR
Other
Enumeration date
12/22/2023
Last updated
12/22/2023
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