Organization
NYSTROM THERAPUTIC MASSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. YARLEY NYSTROM L.M.T. (OWNER)
(503) 756-9076
Entity
Organization
Contact information
Practice address
9900 SW WILSHIRE ST STE 190-E, PORTLAND, OR 97225-5035
(503) 756-9076
(503) 297-3827
Mailing address
9900 SW WILSHIRE ST STE 190-E, PORTLAND, OR 97225-5035
(503) 756-9076
(503) 297-3827
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11353
OR
Other
Enumeration date
06/02/2010
Last updated
05/24/2013
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