Individual
HANNAH HEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10151 SW BARBUR BLVD, SUITE 200, PORTLAND, OR 97219-5931
(503) 245-0454
Mailing address
10151 SW BARBUR BLVD, SUITE 200, PORTLAND, OR 97219-5931
(503) 245-0454
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
19485
OR
225700000X
Massage Therapist
Primary
19485
OR
Other
Enumeration date
09/16/2014
Last updated
09/16/2014
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