Individual
JUSTIN FRIEND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17230
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17230
STATE OF OREGON, BOARD OF MASSAGE THERAPIST
OR
Enumeration date
10/05/2010
Last updated
04/29/2011
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