Individual
MISS BRENNA R SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
925 NW 19TH AVE, SUITE C, PORTLAND, OR 97209-1418
(503) 810-2298
Mailing address
925 NW 19TH AVE, SUITE C, PORTLAND, OR 97209-1418
(503) 810-2298
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12891
OR
Other
Enumeration date
03/17/2010
Last updated
03/17/2010
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