NPI 1003172412

Chung So, LMTOREGON

Practitioner Massage Therapist Portland, OR

Practice location

Address: 1616 SE Bybee Blvd, Portland, OR 97202-5715
Phone: (503) 236-4654
Mailing address: 6311 NW Firwood Drive, Vancouver, WA 98665-8511

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence LMT#4132 (OR)

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Registry record

NPI: 1003172412
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Apr 2012
Record last updated: 10 Apr 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.