Provider Demographics
NPI:1467328120
Name:HOUSTON, LYDIA GRACE (LMT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:GRACE
Last Name:HOUSTON
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 1:2158 NW QUINCE AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7723
Mailing Address - Country:US
Mailing Address - Phone:541-306-8280
Mailing Address - Fax:541-306-8280
Practice Address - Street 1:382 E HOOD AVE STE C
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1620
Practice Address - Country:US
Practice Address - Phone:541-306-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-10
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist