Individual
KEVIN MOORE I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2617 NW THURMAN ST, SUITE 3, PORTLAND, OR 97210-2202
(503) 224-4599
Mailing address
2617 NW THURMAN ST, SUITE 3, PORTLAND, OR 97210-2202
(503) 224-4599
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7647
OR
Other
Enumeration date
02/23/2007
Last updated
07/08/2007
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