Individual
MARK MASON RETZLAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
11220 SE STARK ST STE 6, PORTLAND, OR 97216-3384
(541) 221-3084
Mailing address
11912 SE SCHILLER ST UNIT A, PORTLAND, OR 97266-3269
(541) 221-3084
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18181
OR
Other
Enumeration date
06/07/2011
Last updated
07/21/2022
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