Provider Demographics
NPI:1154557304
Name:CORDERY, RACHEL MEHANA (LMT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MEHANA
Last Name:CORDERY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:MEHANA
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8070 SW HALL BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008
Mailing Address - Country:US
Mailing Address - Phone:503-643-0156
Mailing Address - Fax:971-732-5624
Practice Address - Street 1:8070 SW HALL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6419
Practice Address - Country:US
Practice Address - Phone:503-643-0156
Practice Address - Fax:971-732-5624
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist