Provider Demographics
NPI:1093922395
Name:ALDRIDGE, DENISE MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:ALDRIDGE
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 1:6813 CORREGIDOR RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1615
Mailing Address - Country:US
Mailing Address - Phone:503-997-9519
Mailing Address - Fax:
Practice Address - Street 1:8196 SW HALL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6409
Practice Address - Country:US
Practice Address - Phone:503-997-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist