Provider Demographics
NPI:1679908040
Name:LAUGHLIN, TERESA LYNN (LMT)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LYNN
Last Name:LAUGHLIN
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 1:3145 NE FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3371
Mailing Address - Country:US
Mailing Address - Phone:503-523-8125
Mailing Address - Fax:
Practice Address - Street 1:506 SW 6TH AVE
Practice Address - Street 2:SUITE 801
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1533
Practice Address - Country:US
Practice Address - Phone:503-241-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist