Provider Demographics
NPI:1447528054
Name:TINKER LOWDER, DANYELLE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:DANYELLE
Middle Name:MARIE
Last Name:TINKER LOWDER
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 1:5575 NE SANDYCREST TER APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2646
Mailing Address - Country:US
Mailing Address - Phone:503-881-4786
Mailing Address - Fax:
Practice Address - Street 1:1785 NE SANDY BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2850
Practice Address - Country:US
Practice Address - Phone:503-208-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18597225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist