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Individual

HENRY CARPENTER FORTUNA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
2505 SW SPRING GARDEN ST STE 100, PORTLAND, OR 97219-3966
(503) 841-6222
Mailing address
3636 S KELLY AVE, PORTLAND, OR 97239-4331

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
27508
OR

Other

Enumeration date
03/15/2023
Last updated
03/15/2023
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