Individual
AMY GRACE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2311 E BURNSIDE ST, PORTLAND, OR 97214-2576
(503) 208-8843
Mailing address
2311 E BURNSIDE ST, PORTLAND, OR 97214-2576
(503) 208-8843
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25763
OR
Other
Enumeration date
11/17/2020
Last updated
04/24/2021
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