Organization
ELITE BODY THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE THOMPSON L.M.T. (OWNER LICENSED MASSAGE THERAPIST)
(503) 544-7778
Entity
Organization
Contact information
Practice address
4839 NE MARTIN LUTHER KING JR BLVD, SUITE 201, PORTLAND, OR 97211-3386
(503) 544-7778
Mailing address
5803 SE WOODSTOCK BLVD STE 2, PORTLAND, OR 97206-6705
(503) 544-7778
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13636
OR
Other
Enumeration date
02/07/2012
Last updated
08/02/2012
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