Individual
BLAKE WP FRASER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT
Contact information
Practice address
1125 SE DIVISION ST STE 204, PORTLAND, OR 97202-2567
(682) 622-6602
Mailing address
1125 SE DIVISION ST STE 204, PORTLAND, OR 97202-2567
(682) 622-6602
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26427
OR
Other
Enumeration date
09/22/2020
Last updated
02/01/2024
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