Individual
ELIZABETH ELLEN JOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
1016 SE 12TH AVE, PORTLAND, OR 97214-2513
(503) 484-7432
Mailing address
2534 SE SALMON ST, PORTLAND, OR 97214-3948
(503) 484-7432
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10349
OR
Other
Enumeration date
09/11/2006
Last updated
07/08/2007
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