Individual
JENNIFER L WYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, CMMP
Contact information
Practice address
1224 SW MORRISON ST, PORTLAND, OR 97205-2218
(503) 732-0011
(678) 666-7128
Mailing address
21131 S JUBB RD, ESTACADA, OR 97023-8629
(503) 732-0011
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
18843
OR
225700000X
Massage Therapist
Primary
18843
OR
Other
Enumeration date
08/09/2012
Last updated
03/17/2018
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