MR. Andrei Vladimirovich Mitsourov, LMP
NPI #1205104775 in Milton Freewater, Oregon
Provider Information
- NPI Number
- 1205104775
- Entity Type
- Individual
- Name
- MR. Andrei Vladimirovich Mitsourov, LMP
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Massage Therapist
- Credential
- LMP
- Enumeration Date
- Dec 12, 2011
- Last Updated
- Dec 12, 2011
Practice Location
- Address
- 53387 W CROCKETT RD
- City
- Milton Freewater
- State
- Oregon
- ZIP Code
- 97862-7941
- Phone
- (509) 540-1665
Specialties & Taxonomy Codes
| Specialty |
|---|
| Massage Therapist |
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