NPI 1053683813

Brian Soderholm, LMT

Practitioner Mechanotherapist Gresham, OR

Practice location

Address: 22400 SE Stark St, Gresham, OR 97030-2656
Phone: (503) 491-5555
Fax: (503) 674-5005
Mailing address: 3536 N Commercial Ave, Portland, OR 97227-1308

Registered specialties (2)

Mechanotherapist Primary

Other Service Providers Taxonomy 172M00000X Licence 18501 (OR)

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Massage Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence 18501 (OR)

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Registry record

NPI: 1053683813
Entity type: Individual
Sex (as registered): Male
NPI issued: 8 Feb 2012
Record last updated: 8 Feb 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.