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General NPI Number Information
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NPI Number | 1023931599
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Entity Type | Individual
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Provider Name | MR. CORUM BLUE WRIGHT
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Gender | Male
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 2024 SE CLINTON ST
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City | PORTLAND
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State | OR
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Zip | 97202-2245
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Country | US
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Telephone | 503-238-6262
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Fax |
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Provider Business Mailing Address
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Address Line | 10212 SW CONESTOGA DR APT 50
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City | BEAVERTON
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State | OR
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Zip | 97008-4009
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Country | US
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Telephone | 707-845-9449
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 27327
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License Number State | OR
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