Most Relevant Information
Provider Data
| NPI Number: | 1003319831 |
| Provider Name: | ELLEN LAURA KIMBERLEY LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 24145 |
Most Important Dates
| Enumeration Date: | 03/18/2018 |
| Last Updated: | 03/18/2018 |
Provider Practice Location
7016 SE BOISE ST
PORTLAND
OR
972063453
Practice Location Phone/Fax
| Phone: | 5038494037 |
| Fax: |
Provider Mailing Location
7016 SE BOISE ST
PORTLAND
OR
972063453
Provider Mailing Phone/Fax
| Phone: | 5038494037 |
| Fax: |