Provider Demographics
NPI:1467604082
Name:ANDERSON, TERRI LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:ANDERSON
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 1:200 SW FLORENCE AVE
Mailing Address - Street 2:D15
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7341
Mailing Address - Country:US
Mailing Address - Phone:503-667-3483
Mailing Address - Fax:
Practice Address - Street 1:200 SW FLORENCE AVE
Practice Address - Street 2:D15
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-7341
Practice Address - Country:US
Practice Address - Phone:503-667-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist