Lake Grove Wellness

NPI #1053723536 in Lake Oswego, Oregon

Provider Information

NPI Number: 1053723536
Entity Type: Organization
Organization Name: Lake Grove Wellness
Primary Specialty: Massage Therapist
Enumeration Date: Jun 2, 2014
Last Updated: Jun 2, 2014

Practice Location

Address: 16320 BRYANT RD
City: Lake Oswego
State: Oregon
ZIP Code: 97035-4308
Phone: (503) 908-1180

Authorized Official

Name: KATHLEEEN JORDAN, LMT
Title: OWNER
Phone: (503) 908-1180

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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