NPI 1093950057

Jason Lee Johnson, MASSAGETHERAPIST

Practitioner Contractor Portland, OR

Practice location

Address: 11120 NE Halsey St, Portland, OR 97220-2021
Phone: (503) 252-5097
Mailing address: 15420 SW Mica Ln, Beaverton, OR 97007-9307

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 12553 (OR)

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Registry record

NPI: 1093950057
Entity type: Individual
Sex (as registered): Male
NPI issued: 4 Dec 2008
Record last updated: 4 Dec 2008

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.