Individual
FREDERIC VERNON STUTZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2167 NW 185TH AVE, HILLSBORO, OR 97124-7074
(503) 828-1311
Mailing address
215 NW EDGEWAY DR. APT. 106, HILLSBORO, OR 97006
(503) 680-9862
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18666
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18666
MASSSAGE LICENSE
OR
Enumeration date
08/12/2019
Last updated
08/12/2019
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