Provider Demographics
NPI:1770782617
Name:ALLEN, TERESA J (LMT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:ALLEN
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 1:9860 SW HALL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8896
Mailing Address - Country:US
Mailing Address - Phone:503-709-1568
Mailing Address - Fax:
Practice Address - Street 1:2604 SW 64TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-8168
Practice Address - Country:US
Practice Address - Phone:503-709-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7084225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist