Individual
MACKENZIE JOHN MUNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
930 SW HALL ST, PORTLAND, OR 97201
(503) 312-8752
Mailing address
4385 NW PALO VERDE PL, BEAVERTON, OR 97006-7484
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-10205491
OR
Other
Enumeration date
07/01/2025
Last updated
07/01/2025
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