Provider Demographics
NPI:1487828125
Name:LOEWY, MARY SHANNON (MASSAGE THERIPST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SHANNON
Last Name:LOEWY
Suffix:
Gender:F
Credentials:MASSAGE THERIPST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SW 195TH AVE UNIT 126
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5539
Mailing Address - Country:US
Mailing Address - Phone:503-591-8026
Mailing Address - Fax:
Practice Address - Street 1:6900 SW 195TH AVE UNIT 126
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97007-5539
Practice Address - Country:US
Practice Address - Phone:503-591-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12715225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist