Organization
BACK TO THE SOURCE
Active
Other names
Back to the Source
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE ROBINSON LMT (OWNER)
(503) 892-8787
Entity
Organization
Contact information
Practice address
823 NE BROADWAY ST, PORTLAND, OR 97232-1215
(503) 892-8787
Mailing address
823 NE BROADWAY ST, PORTLAND, OR 97232-1215
(503) 892-8787
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
01/12/2018
Last updated
01/12/2018
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