Individual
DAVID C DEROSIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2143 NE BROADWAY ST STE 1, PORTLAND, OR 97232-1512
(971) 303-8367
Mailing address
2143 NE BROADWAY ST STE 1, PORTLAND, OR 97232-1512
(971) 303-8367
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16541
OR
Other
Enumeration date
03/03/2011
Last updated
04/07/2021
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