Individual
KEITH ALLEN DAGENHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7770 SW ALESON ROAD, PORTLAND, OR 97223
(503) 245-2752
Mailing address
38795 DUBALKO ROAD, SANDY, OR 97055
(503) 668-9309
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7232
OR
Other
Enumeration date
07/28/2006
Last updated
07/08/2007
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