Individual provider · Type 1 NPI

Justin Clark, LMT

Massage Therapist · Portland, OR

NPI number 1013286863 Active

Practice location

12923 NW Cornell Rd, #201
Portland, OR 97229-5834

Call (503) 646-3393 Map

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000X18505 (OR)

Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

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About NPI 1013286863

Justin Clark, LMT's National Provider Identifier is 1013286863, issued on Dec 23, 2011. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Portland, OR. The record was last updated on Dec 23, 2011.