Provider Demographics
NPI:1033458732
Name:LORD, CODI JOY (LMT)
Entity Type:Individual
Prefix:
First Name:CODI
Middle Name:JOY
Last Name:LORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 NW SCHMIDT WAY APT 143
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4789
Mailing Address - Country:US
Mailing Address - Phone:503-943-9596
Mailing Address - Fax:
Practice Address - Street 1:18879 SW TV HWY
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-2833
Practice Address - Country:US
Practice Address - Phone:503-649-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist