Individual
MICHAEL A KOSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3333 SW MILLER PL, GRESHAM, OR 97080-5500
(503) 839-5335
Mailing address
3333 SW MILLER PL, GRESHAM, OR 97080-5500
(503) 839-5335
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023412
OR
Other
Enumeration date
02/23/2020
Last updated
02/23/2020
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