Individual
KYZEN PEMBERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2305 SE 50TH AVE STE 200, PORTLAND, OR 97215-3853
(971) 222-4810
Mailing address
4140 SE 37TH AVE APT 2, PORTLAND, OR 97202-3272
(971) 222-4810
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
28441
OR
Other
Enumeration date
08/10/2024
Last updated
08/10/2024
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