Provider Demographics
NPI:1144527193
Name:ANDRADE, BRYAN (LMT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6204
Mailing Address - Country:US
Mailing Address - Phone:503-621-8055
Mailing Address - Fax:
Practice Address - Street 1:1915 NW AMBERGLEN PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6951
Practice Address - Country:US
Practice Address - Phone:503-621-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14760172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist