Individual
MRS. TYNA RENEE MILDREXLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
1531 SW MARKET ST, PORTLAND, OR 97201-2556
(503) 701-9634
Mailing address
1531 SW MARKET ST, PORTLAND, OR 97201-2556
(503) 701-9634
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
6666
OR
Other
Enumeration date
05/27/2009
Last updated
05/27/2009
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