Individual
JONATHAN MARK FESSLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA, FNTP, LMT, CA
Contact information
Practice address
1825 NE BROADWAY ST STE F, PORTLAND, OR 97232-4433
(503) 830-0069
Mailing address
1825 NE BROADWAY ST STE F, PORTLAND, OR 97232-4433
(503) 830-0069
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20420
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629489190
LMT
OR
01
—
20420
LICENSE MASSAGE THERAPIST
OR
Enumeration date
05/18/2014
Last updated
12/10/2019
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