Individual provider · Type 1 NPI

Ausa Peacock, LMT

Massage Therapist · Portland, OR

NPI number 1720331366 Active

Practice location

833 SE Main St # 423
Portland, OR 97214-3454

Call (503) 583-2872 Map

Mailing address

6326 NE 25th Ave
Portland, OR 97211-6044

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000X15125 (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 1720331366

Ausa Peacock, LMT's National Provider Identifier is 1720331366, issued on Oct 19, 2012. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Portland, OR. The record was last updated on Oct 19, 2012.