Individual
LISA ANN BOURLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
238 SE 2 AVENUE, BEAVERTON, OR 97123
(503) 358-3385
Mailing address
13345 SW BRIGHTWOOD STREET, BEAVERTON, OR 97005-1222
(503) 358-3385
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14779
OR
Other
Enumeration date
01/23/2009
Last updated
01/23/2009
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