Provider Demographics
NPI:1154636504
Name:TODD, MINDY IVY (LMT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:IVY
Last Name:TODD
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 1:7246 SW 176TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6410
Mailing Address - Country:US
Mailing Address - Phone:808-731-9551
Mailing Address - Fax:
Practice Address - Street 1:10445 SW CANYON RD STE 270
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1938
Practice Address - Country:US
Practice Address - Phone:808-731-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16581OtherOREGON MEDICAL BOARD