Provider Demographics
NPI:1033451109
Name:SHUMAN, ANDREA BETH (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:BETH
Last Name:SHUMAN
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 1:5505 SE WOODSTOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6828
Mailing Address - Country:US
Mailing Address - Phone:541-788-3313
Mailing Address - Fax:
Practice Address - Street 1:5505 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6828
Practice Address - Country:US
Practice Address - Phone:541-788-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9632 MASSAGE THERAPY173C00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist