Individual provider · Type 1 NPI

Johnnie San Nicolas

Massage Therapist · Portland, OR

NPI number 1760079347 Active

Practice location

3241 NE Broadway St
Portland, OR 97232-1814

Call (503) 282-8582 Map

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000X26117 (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 1760079347

Johnnie San Nicolas's National Provider Identifier is 1760079347, issued on Dec 29, 2020. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Portland, OR. The record was last updated on Dec 29, 2020.