Most Relevant Information
Provider Data
| NPI Number: | 1003239104 |
| Provider Name: | JACKSON LEE ANDREWS LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 20031 |
Most Important Dates
| Enumeration Date: | 01/24/2014 |
| Last Updated: | 01/24/2014 |
Provider Practice Location
7380 SW REIF RD
POWELL BUTTE
OR
977531513
Practice Location Phone/Fax
| Phone: | 5412130491 |
| Fax: |
Provider Mailing Location
7380 SW REIF RD
POWELL BUTTE
OR
977531513
Provider Mailing Phone/Fax
| Phone: | 5412130491 |
| Fax: |