Ethan Lively
Ethan Lively is a Massage Therapist in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2022.
- Licensed in
- OR
- In the registry since
- 2022
Practice location Address checks out
2149 NE Broadway StPortland, OR 97232-1580
Phone: (503) 281-0278
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Massage Therapist (primary) | Taxonomy 225700000X · Licence 27378 (OR) |
|---|
Record details
| NPI number | 1841908001 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | November 7, 2022 |
| Last updated in NPPES | November 7, 2022 |
| Certification date | November 7, 2022 |
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