Individual
MR. JOHNATHAN ANDREW KRUG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2149 NE BROADWAY ST, PORTLAND, OR 97232-1580
(503) 281-0278
Mailing address
3119 NE 65TH AVE, PORTLAND, OR 97213-4535
(503) 995-8158
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25956
OR
Other
Enumeration date
10/21/2022
Last updated
10/21/2022
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