Individual
JOIE JAMES BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
10915 SE STARK ST, PORTLAND, OR 97216-3348
(503) 261-1120
Mailing address
6646 NE 63RD AVE, PORTLAND, OR 97218-2724
(503) 314-6408
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24478
OR
Other
Enumeration date
11/09/2018
Last updated
11/09/2018
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