Individual
CARLY BENTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4265 SW 109TH AVE, BEAVERTON, OR 97005-3028
(503) 526-8600
Mailing address
4265 SW 109TH AVE, BEAVERTON, OR 97005-3028
(503) 526-8600
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21199
OR
Other
Enumeration date
04/03/2015
Last updated
04/03/2015
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