Individual
COLLEEN ALICIA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
430 SW 13TH AVE, PORTLAND, OR 97205-2361
(503) 544-8726
Mailing address
430 SW 13TH AVE, PORTLAND, OR 97205-2361
(503) 544-8726
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16502
OR
Other
Enumeration date
03/05/2011
Last updated
03/05/2011
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