Individual
IMIA ALEXANDRA HOLSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4515 SW CORBETT AVE, PORTLAND, OR 97239-4289
(503) 224-5464
Mailing address
4409 NE KILLINGSWORTH ST UNIT 103, PORTLAND, OR 97218-1465
(773) 504-4804
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25192
OR
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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