Individual
JONATHAN R PRUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2015 NE 39TH AVE, PORTLAND, OR 97212-5305
(503) 753-2233
Mailing address
2015 NE 39TH AVE, PORTLAND, OR 97212-5305
(503) 753-2233
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11061
OR
Other
Enumeration date
07/02/2009
Last updated
07/02/2009
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