Individual
KIM LOVELACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1715 E BURNSIDE ST, PORTLAND, OR 97214-1531
(503) 756-4034
Mailing address
1718 NE TILLAMOOK ST, PORTLAND, OR 97212-4605
(503) 756-4034
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11751
OR
Other
Enumeration date
10/28/2006
Last updated
07/08/2007
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