Individual
MR. MICHAEL THOMAS MONTEBLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3716 SE INTERNATIONAL WAY, PORTLAND, OR 97222-6001
(503) 659-0073
Mailing address
12505 SW NORTH DAKOTA ST APT 1003, TIGARD, OR 97223-3289
(503) 750-8996
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24573
OR
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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