Individual
KRYSTINA ALEXIA QUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1330 SE 39TH AVE, PORTLAND, OR 97214-4322
(503) 232-1200
Mailing address
6403 SE 73RD AVE, PORTLAND, OR 97206-6418
(503) 997-7215
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14201
OR
Other
Enumeration date
06/10/2009
Last updated
06/10/2009
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