Individual
LYLE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2003 NE HOLMAN ST, PORTLAND, OR 97211-5478
(504) 503-2975
Mailing address
7409 N KNOWLES AVE, PORTLAND, OR 97217-1231
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
29177
OR
Other
Enumeration date
01/22/2026
Last updated
01/22/2026
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