Janice Modesitt Lmt

NPI #1639438419 in Lake Oswego, Oregon

Provider Information

NPI Number: 1639438419
Entity Type: Organization
Organization Name: Janice Modesitt Lmt
Primary Specialty: Clinic/Center
Enumeration Date: May 14, 2012
Last Updated: May 14, 2012

Practice Location

Address: 16463 BOONES FERRY RD
Address 2: STE. 100
City: Lake Oswego
State: Oregon
ZIP Code: 97035-4259
Phone: (503) 699-2955

Authorized Official

Name: MRS. JANICE CAROLE MODESITT, L.M.T.
Title: LICENSED MASSAGE THERAPIST
Phone: (503) 699-2955

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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