Individual
BRADLEY BLAZER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
104 5TH ST, HOOD RIVER, OR 97031-2058
(541) 490-1444
Mailing address
411 JOHNSON AVE, LYLE, WA 98635-9046
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23208
OR
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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