Provider Demographics
NPI:1982031035
Name:GRYDER, TERESA (ND)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:GRYDER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 SW NEVADA CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1513
Mailing Address - Country:US
Mailing Address - Phone:503-479-5426
Mailing Address - Fax:
Practice Address - Street 1:5125 SW MACADAM AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3820
Practice Address - Country:US
Practice Address - Phone:503-684-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1944175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath