Individual
CASEY TYRONE GATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
3109 NE BROADWAY ST STE B, PORTLAND, OR 97232-1812
(971) 413-3106
Mailing address
4118 SE YAMHILL ST, PORTLAND, OR 97214-4447
(971) 413-3106
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023247
OR
Other
Enumeration date
08/24/2017
Last updated
08/24/2017
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