Provider Demographics
NPI:1619539970
Name:TOWLE, BRITTANY DANIELLE (LMT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DANIELLE
Last Name:TOWLE
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 1:4926 SW 56TH AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1975
Mailing Address - Country:US
Mailing Address - Phone:615-767-1879
Mailing Address - Fax:
Practice Address - Street 1:1224 SW MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2218
Practice Address - Country:US
Practice Address - Phone:615-767-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-07
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25107225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist