Organization
AUDRA ERICKSON, LMT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AUDRA GALE ERICKSON BS, LMT (LICENSED MASSAGE THERAPIST)
(541) 484-7563
Entity
Organization
Contact information
Practice address
4415 NE SANDY BLVD STE 207, PORTLAND, OR 97213-1400
(541) 484-7563
Mailing address
3829 SE 68TH AVE, PORTLAND, OR 97206-3527
(541) 484-7563
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21710
LMT
OR
Enumeration date
09/25/2018
Last updated
01/12/2021
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