Individual
MR. MICHAEL BENJAMIN SUMNER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
390 SALEM HEIGHTS AVE S, SALEM, OR 97302-5609
(503) 371-1901
Mailing address
390 SALEM HEIGHTS AVE S, SALEM, OR 97302-5609
(503) 371-1901
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
10763
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10763
LMT LISENCE
OR
Enumeration date
05/13/2007
Last updated
07/08/2007
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