Organization
ADVANCE INJURY CARE AND MOVEMENT THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD WALTER ROSKOPF LMT (OWNER)
(503) 939-2524
Entity
Organization
Contact information
Practice address
11507 SW SHILO LN, STE E, PORTLAND, OR 97225-5923
(503) 939-2524
(503) 520-0514
Mailing address
11507 SW SHILO LN, STE E, PORTLAND, OR 97225-5923
(503) 939-2524
(503) 520-0514
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9601
OR
Other
Enumeration date
08/26/2011
Last updated
08/26/2011
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