Individual
MR. DONOVAN JOSEPH MONROE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1988 SE LADD AVE, PORTLAND, OR 97214-4737
(503) 984-1963
Mailing address
1988 SE LADD AVE, PORTLAND, OR 97214-4737
(503) 984-1963
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10214
OR
Other
Enumeration date
01/09/2009
Last updated
01/09/2009
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