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1730699976
LISA D BLAKE
PORTLAND, OR
NPI
1730699976
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
225700000X Massage Therapist
(Licence: OR 18230)
Enumeration Date
2017-10-02
Last Update Date
2017-10-02
Business Address
LISA D BLAKE LMT
2705 E BURNSIDE ST STE 213
PORTLAND, OR 97214-1768
Phone number: 503-234-4288
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Mailing Address
LISA D BLAKE LMT
5319 SE 69TH AVE
PORTLAND, OR 97206-5343
Phone number: 603-219-1318
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