| NPI | 1326473075 |
|---|---|
| Doing Business As | BODYLOGICMD OF PORTLAND |
| Entity Type | Organization |
| Authorized Contact | AMY KILLEN Owner / Physician 512-767-8105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OR MD164143) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2013-09-12 |