Stephen S Bullock, LMT
Massage Therapist in Portland, OR. Individual provider (NPI-1).
NPI number1164061016
StatusActive
Last updated in NPPESDec 24, 2019
Details
- NPI
- 1164061016
- Entity type
- Individual (NPI-1)
- Name
- Stephen S Bullock
- Credential
- LMT
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 24, 2019
- Certification date
- Dec 24, 2019
- Last updated
- Dec 24, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 25530 | OR | Yes |
Practice location
1720 Sw 4th Ave Apt 313Portland, OR 97201-5531
Phone 443-562-9635
Mailing address
1720 Sw 4th Ave Apt 313Portland, OR 97201-5531
Phone 443-562-9635
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