Individual
BENJAMIN WURTSBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2526 NE 15TH AVE, PORTLAND, OR 97212-4222
(503) 288-7668
Mailing address
609 SE 58TH AVE, PORTLAND, OR 97215-1825
(707) 490-9682
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23585
OR
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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