Individual
MRS. MARY NICOLE GRIZHUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
17221 SE DIVISION ST, PORTLAND, OR 97236-1240
(503) 760-0778
Mailing address
13058 FRONTIER PKWY, OREGON CITY, OR 97045-7738
(503) 753-0541
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
14584
OR
225700000X
Massage Therapist
Primary
LMT-14584
OR
Other
Enumeration date
11/30/2017
Last updated
11/30/2017
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