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Individual

MR. BRETON DAN SIMMONS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
16742 SE DIVISION ST, PORTLAND, OR 97236-1414
(971) 285-7868
Mailing address
12522 SW 123RD AVE, TIGARD, OR 97223-3058
(971) 285-7868

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11607
OR

Other

Enumeration date
06/03/2009
Last updated
06/03/2009
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