Individual
MR. MICHAEL LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
3810 SE BELMONT ST, PORTLAND, OR 97214-4330
(503) 449-1932
Mailing address
3810 SE BELMONT ST, PORTLAND, OR 97214-4330
(503) 449-1932
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6194
OR
Other
Enumeration date
05/09/2008
Last updated
01/04/2009
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