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General NPI Number Information
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NPI Number | 1700233277
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Entity Type | Organization
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Legal Business Name | J. JAMES THERAPY & MASSAGE
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Dates
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Enumeration Date | 05/15/2016
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Last Update Date | 05/15/2016
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Provider Practice Location Address
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Address Line | 0224 SW HAMILTON ST
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City | PORTLAND
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State | OR
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Zip | 97239-6418
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Country | US
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Telephone | 941-323-5905
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9052
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City | PORTLAND
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State | OR
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Zip | 97207-9052
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Country | US
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Telephone | 503-543-4747
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED GREEN
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Credential | LMP
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Telephone | 503-543-4747
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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 | 22127
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License Number State | OR
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