Individual
KELLY ALYSA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT, BCTMB
Contact information
Practice address
12725 SW 66TH AVE STE 205, TIGARD, OR 97223-2548
(971) 245-5699
Mailing address
15390 SW KENTON DR, TIGARD, OR 97224-7371
(503) 639-8768
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26594
OR
Other
Enumeration date
04/03/2023
Last updated
04/03/2023
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