Individual
NICKOLAS MIESLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
3327 NE 68TH AVE, PORTLAND, OR 97213-5221
(503) 756-6170
Mailing address
3327 NE 68TH AVE, PORTLAND, OR 97213-5221
(503) 756-6170
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18774
OR
Other
Enumeration date
02/17/2012
Last updated
02/17/2012
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