Ethan Lively is a Massage Therapist based in Portland, OR. Ethan Lively practices in Portland, OR. The NPI Number for Ethan Lively is 1841908001 and holds a License No. 27378 (Oregon).
The current practice location address for Ethan Lively is 2149 Ne Broadway St, Portland, OR and can be reached out via phone at 503-281-0278.
Location: 2149 Ne Broadway St, Portland, OR, 97230-7359
Provider Profile Details
NPI Number
1841908001
Provider Name
Ethan Lively
Credential
Provider Entity Type
Individual
Gender
Male
Address
2149 Ne Broadway St, Portland, OR, 97230-7359
Phone Number
503-281-0278
Fax Number
Provider Enumeration Date
11/07/2022
Last Update Date
03/10/2024
Provider Business Practice Location Address Details
Address
2149 Ne Broadway St
City
State
Zip
97232-1580
Phone Number
503-281-0278
Fax Number
Provider Business Mailing Address Details
Address
2149 Ne Broadway St
City
State
Zip
97232-1580
Phone Number
503-281-0278
Fax Number
Provider's Taxonomy Details 1
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification
Massage Therapist
Speciality
-
Taxonomy
License No.
27378 (Oregon)
Definition
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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