Provider Demographics
NPI:1073970729
Name:BYRNES, WYNTER (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:WYNTER
Middle Name:
Last Name:BYRNES
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 NE 32ND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6965
Mailing Address - Country:US
Mailing Address - Phone:503-270-1703
Mailing Address - Fax:
Practice Address - Street 1:18676 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8435
Practice Address - Country:US
Practice Address - Phone:971-404-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7453172M00000X
OR851399171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No172M00000XOther Service ProvidersMechanotherapist