Individual
BRYAN TWIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8695 SW JACK BURNS BLVD, WILSONVILLE, OR 97070-5797
(503) 427-2698
Mailing address
2040 N REDWOOD ST APT 20, CANBY, OR 97013-2453
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15448
OR
Other
Enumeration date
07/18/2015
Last updated
07/18/2015
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