Provider Demographics
NPI:1578908893
Name:LLOYD, TRACY (LMT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:LLOYD
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 1:6441 SW CANYON CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1458
Mailing Address - Country:US
Mailing Address - Phone:503-546-4223
Mailing Address - Fax:
Practice Address - Street 1:6441 SW CANYON CT
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1458
Practice Address - Country:US
Practice Address - Phone:503-546-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7807225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist