Individual
MARY EBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5905 NE 15TH AVE, PORTLAND, OR 97211-4940
(503) 809-1085
Mailing address
5905 NE 15TH AVE, PORTLAND, OR 97211-4940
(503) 809-1085
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20918
OR
Other
Enumeration date
10/22/2014
Last updated
10/22/2014
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