Chung So, LMT(OREGON #4132)

NPI #1003172412 in Portland, Oregon

Provider Information

NPI Number: 1003172412
Entity Type: Individual
Name: Chung So, LMT(OREGON #4132)
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT(OREGON #4132)
Enumeration Date: Apr 10, 2012
Last Updated: Apr 10, 2012

Practice Location

Address: 1616 SE BYBEE BLVD
City: Portland
State: Oregon
ZIP Code: 97202-5715
Phone: (503) 236-4654

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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