Individual
MR. ALEX SUSBAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, BCSI (CM)
Contact information
Practice address
2135 SE 76TH AVE, PORTLAND, OR 97215-4103
(503) 201-9449
(503) 777-6077
Mailing address
2135 SE 76TH AVE, PORTLAND, OR 97215-4103
(503) 201-9449
(503) 777-6077
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
8205
OR
Other
Enumeration date
01/19/2012
Last updated
01/19/2012
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