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General NPI Number Information
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NPI Number | 1639819360
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Entity Type | Organization
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Legal Business Name | FINE TUNE MASSAGE PDX
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 820 NW 21ST AVE STE B
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City | PORTLAND
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State | OR
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Zip | 97209-1449
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Country | US
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Telephone | 971-319-3337
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Fax |
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Provider Business Mailing Address
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Address Line | 550 NW 19TH AVE APT 301
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City | PORTLAND
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State | OR
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Zip | 97209-2091
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Country | US
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Telephone | 971-707-0628
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Fax | 971-606-2146
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | CLAYTON STUHR
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Credential | LMT
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Telephone | 971-707-0628
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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 |
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License Number State |
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