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General NPI Number Information
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NPI Number | 1720381098
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Entity Type | Individual
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Provider Name | JULIAN CANGILOSE L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 1328 NW 6TH STREET
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City | GRANTS PASS
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State | OR
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Zip | 97526-1255
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Country | US
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Telephone | 541-660-5559
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 664
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City | GRANTS PASS
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State | OR
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Zip | 97528-0057
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Country | US
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Telephone | 541-660-5559
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Fax | 541-474-6310
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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 | 15467
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License Number State | OR
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