Provider Demographics
NPI:1093584740
Name:KAUFMANN, SHINNEAKA L (LMT)
Entity Type:Individual
Prefix:
First Name:SHINNEAKA
Middle Name:L
Last Name:KAUFMANN
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 1:2710 NE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3143
Mailing Address - Country:US
Mailing Address - Phone:503-440-0942
Mailing Address - Fax:
Practice Address - Street 1:24076 SE STARK ST STE 310
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3386
Practice Address - Country:US
Practice Address - Phone:503-440-0942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist