Provider Demographics
NPI:1245425628
Name:TITTERINGTON, RICHARD (LMP, LMT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:TITTERINGTON
Suffix:
Gender:M
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 NE 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6749
Mailing Address - Country:US
Mailing Address - Phone:503-998-9144
Mailing Address - Fax:
Practice Address - Street 1:3305 MAIN ST
Practice Address - Street 2:SUITE 117
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2255
Practice Address - Country:US
Practice Address - Phone:503-998-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024619225700000X
OR12890225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist