Individual
LISA D BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2705 E BURNSIDE ST STE 213, PORTLAND, OR 97214-1768
(503) 234-4288
Mailing address
5319 SE 69TH AVE, PORTLAND, OR 97206-5343
(603) 219-1318
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18230
OR
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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