Individual
LORA GENEVA EDMISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
604 NW 23RD AVE, SUITE #2, PORTLAND, OR 97210-3209
(503) 708-9049
Mailing address
710 NW NAITO PKWY, C-17, PORTLAND, OR 97209-3758
(503) 860-5288
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14753
OR
Other
Enumeration date
07/06/2010
Last updated
07/06/2010
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