Individual
ALTA ULRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7932 SE 282ND AVE, GRESHAM, OR 97080-8217
(503) 501-6312
Mailing address
7932 SE 282ND AVE, GRESHAM, OR 97080-8217
(503) 501-6312
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17399
OR
Other
Enumeration date
09/08/2016
Last updated
09/08/2016
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