BODYWORK FOR THE ACTIVE
Medical Practice at Vaughn St, Portland, OR

License number
Oregon 15490
Category
Medical Practice
Type
Mechanotherapist
Owner
Name: MR. RICARD M DEAUSTRIA JR. LMT
Title: OWNER/LMT
Phone: (971) 246-0057
Address
Address
2701 NW Vaughn St STE 154, Portland, OR 97210
National Provider ID: 1528486982
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about BODYWORK FOR THE ACTIVE at bizstanding.com

BODYWORK FOR THE ACTIVE

2608 NE Sandy Blvd, Portland, OR 97232

Registration:
Jan 31, 2012
State ID:
83061490
Business type:
ASSUMED BUSINESS NAME
Agent:
Ricardo Malilomdeaustria,2701 NW Vaughn SUITE 154, Portland, OR 97210 (Physical)

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