Individual
KELLY KRUG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
9129 NE GLISAN ST, PORTLAND, OR 97220-5865
(608) 397-6821
Mailing address
9129 NE GLISAN ST, PORTLAND, OR 97220-5865
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24445
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24445
LMT
OR
Enumeration date
02/01/2021
Last updated
02/01/2021
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