Organization
ORENCO MASSAGE STUDIO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD STANLEY WILK JR. LMP, LMT, MBA (PRESIDENT/SECRETARY)
(360) 910-1840
Entity
Organization
Contact information
Practice address
1915 NW AMBERGLEN PKWY, SUITE #400, BEAVERTON, OR 97006-6951
(360) 910-1840
Mailing address
5841 NE ORENCO GARDENS DR, HILLSBORO, OR 97124-5128
(360) 910-1840
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
LMT#6259
OR
Other
Enumeration date
02/09/2015
Last updated
02/09/2015
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