Individual
JACOB SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
8137 SW 40TH AVE, PORTLAND, OR 97219-3502
(503) 896-1396
Mailing address
8137 SW 40TH AVE, PORTLAND, OR 97219-3502
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17775
OR
Other
Enumeration date
07/31/2012
Last updated
07/31/2012
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