Individual
MINDY IVY TODD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10445 SW CANYON RD STE 270, BEAVERTON, OR 97005-1938
(808) 731-9551
Mailing address
7246 SW 176TH AVE, ALOHA, OR 97007-6410
(808) 731-9551
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16581
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16581
OREGON MEDICAL BOARD
OR
Enumeration date
08/10/2010
Last updated
05/05/2022
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