Provider Demographics
NPI:1518624485
Name:TERESZCZENKO, ALEXANDRA LESIA (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LESIA
Last Name:TERESZCZENKO
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 1:2188 SW PARK PL STE 10
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1100
Mailing Address - Country:US
Mailing Address - Phone:503-568-1390
Mailing Address - Fax:
Practice Address - Street 1:10029 SW NIMBUS AVE STE 230
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7110
Practice Address - Country:US
Practice Address - Phone:503-372-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26402225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist