Individual
MR. MICHAEL T MCNICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7052 SW NYBERG ST, TUALATIN, OR 97062-9231
(503) 766-3366
(503) 766-3366
Mailing address
7052 SW NYBERG ST, TUALATIN, OR 97062-9231
(503) 766-3366
(503) 766-3366
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17929
OR
Other
Enumeration date
04/19/2012
Last updated
04/19/2012
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