Provider Demographics
NPI:1164554499
Name:DAVIS, SHANA SCHONBERG (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:SCHONBERG
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:SHANA
Other - Middle Name:ALICIA
Other - Last Name:SCHONBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:4420 NE 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218
Mailing Address - Country:US
Mailing Address - Phone:503-493-2622
Mailing Address - Fax:503-493-2622
Practice Address - Street 1:3716 SE INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:503-659-0073
Practice Address - Fax:503-659-7471
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7111225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist