Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 11147 | OR |
NPI | 1013140912 |
---|---|
Provider Name | Ms. Gina M Strode |
First Address | Beaverton, OR 97005-0517 |
Second Address | Beaverton, OR 97005-0517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2009 |
Last Update Date | 31/08/2009 |