Individual
BENNY LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2808 NE MARTIN LUTHER KING JR BLVD STE C, PORTLAND, OR 97212-3061
(503) 473-3667
Mailing address
7011 SE ALBERTA ST, PORTLAND, OR 97206-9421
(503) 473-3667
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26616
OR
Other
Enumeration date
12/23/2021
Last updated
05/31/2023
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