Individual
MR. ALEX DANJAI WYATT GARBODEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
102 NE LIBERTY AVE, GRESHAM, OR 97030-7918
(503) 883-1692
Mailing address
102 NE LIBERTY AVE, GRESHAM, OR 97030-7918
(503) 883-1692
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
28631
OR
Other
Enumeration date
12/28/2024
Last updated
12/28/2024
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