Individual
MISS LISA SHORETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1235 SE DIVISION ST STE 117, PORTLAND, OR 97202-1085
(503) 770-0278
Mailing address
3158 SE LAKE RD, MILWAUKIE, OR 97222-6898
(503) 516-9811
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21048
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21048
STATE LICENSE
OR
Enumeration date
01/31/2015
Last updated
01/31/2015
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