Individual
JUAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13815 SW PACIFIC HWY STE 50, TIGARD, OR 97223-4802
(503) 899-9699
Mailing address
13815 SW PACIFIC HWY STE 50, TIGARD, OR 97223-4802
(503) 899-9699
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21743
OR
Other
Enumeration date
01/06/2025
Last updated
01/06/2025
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