Provider Demographics
NPI:1881014256
Name:CHAMBERS, MINDY (LMT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:CHAMBERS
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 1:7555 SW HALL BLVD
Mailing Address - Street 2:#56
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5790
Mailing Address - Country:US
Mailing Address - Phone:503-380-8598
Mailing Address - Fax:
Practice Address - Street 1:3045 SW 207TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-1738
Practice Address - Country:US
Practice Address - Phone:503-380-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist