Provider Demographics
NPI:1770933061
Name:GIFFORD, TODD (COO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:M
Credentials:COO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:16083 SW UPPER BOONES FERRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7736
Practice Address - Country:US
Practice Address - Phone:800-219-8835
Practice Address - Fax:503-639-9699
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR02056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist