Individual
HEIDI MAE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
118 N KILLINGSWORTH ST, PORTLAND, OR 97217-2435
(503) 288-4454
Mailing address
1904 N KILPATRICK ST, PORTLAND, OR 97217-6651
(503) 793-4768
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18117
OR
Other
Enumeration date
09/28/2017
Last updated
09/28/2017
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