Individual
GARY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
551 LONE PINE BLVD, THE DALLES, OR 97058-9403
(541) 506-5788
(541) 296-7390
Mailing address
917 PACIFIC AVE UNIT 19, HOOD RIVER, OR 97031-1983
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18929
OR
Other
Enumeration date
07/03/2013
Last updated
07/03/2013
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