Provider Demographics
NPI:1740349844
Name:PENNINGTON, TODD RICHARD (LMT, NCMMT)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:RICHARD
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:LMT, NCMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 SW BARBUR BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5908
Mailing Address - Country:US
Mailing Address - Phone:503-244-4427
Mailing Address - Fax:503-244-1189
Practice Address - Street 1:10175 SW BARBUR BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5908
Practice Address - Country:US
Practice Address - Phone:503-244-4427
Practice Address - Fax:503-244-1189
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3833225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1150OtherMED MASSAGE NAT'L CERT BD