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Individual

ETHAN W TREVINO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
5253 NE SANDY BLVD, PORTLAND, OR 97213-2562
(503) 893-5131
Mailing address
64770 BIG BUCK DR, DEER ISLAND, OR 97054-9418
(801) 686-3612

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26242
OR

Other

Enumeration date
02/26/2021
Last updated
02/26/2021
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