Organization
JANICE MODESITT LMT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANICE CAROLE MODESITT L.M.T. (LICENSED MASSAGE THERAPIST)
(503) 699-2955
Entity
Organization
Contact information
Practice address
16463 BOONES FERRY RD, STE. 100, LAKE OSWEGO, OR 97035-4259
(503) 699-2955
Mailing address
16463 BOONES FERRY RD, STE. 100, LAKE OSWEGO, OR 97035-4259
(503) 699-2955
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1045
OR
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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