Individual
HAMID SHIBATA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3810 SE BELMONT ST, PORTLAND, OR 97214-4330
(503) 975-1259
Mailing address
3810 SE BELMONT ST, PORTLAND, OR 97214-4330
(503) 975-1259
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
301
OR
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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