Basic Information
| Provider Information | |||||||||
| NPI: | 1306929773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLENDON | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 TROSPER RD SW # 108-133 | ||||||||
| Address2: | |||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985128108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607895142 | ||||||||
| FaxNumber: | 3603528868 | ||||||||
| Practice Location | |||||||||
| Address1: | 677 WOODLAND SQUARE LOOP SE | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985031000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607895142 | ||||||||
| FaxNumber: | 3603528868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA00014851 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.