Individual
MS. MELODY L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
1201 SW12TH AVE, SUITE 205, PORTLAND, OR 97250
(503) 279-0205
(503) 279-0206
Mailing address
PO BOX 6687, PORTLAND, OR 97228-6687
(503) 279-0205
(503) 279-0206
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
3383
OR
Other
Enumeration date
01/20/2009
Last updated
01/20/2009
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