Individual provider · Type 1 NPI

Justin Wycoff, LMT

Massage Therapist · Portland, OR

NPI number 1376993907 Active

Practice location

6030 SE Division St
Portland, OR 97206-1346

Call (503) 772-1215 Map

Mailing address

711 SE 11th Ave, Apt 3
Portland, OR 97214-2451

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000X22208 (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 1376993907

Justin Wycoff, LMT's National Provider Identifier is 1376993907, issued on Jun 14, 2016. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Portland, OR. The record was last updated on Jun 14, 2016.