Individual
MATT WORLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2572 NW VAUGHN ST, APT D., PORTLAND, OR 97210-2555
(971) 570-5870
Mailing address
2572 NW VAUGHN ST, APT D., PORTLAND, OR 97210-2555
(971) 570-5870
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21346
OR
Other
Enumeration date
05/07/2015
Last updated
05/07/2015
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