Provider Demographics
NPI:1518190727
Name:GERRY, SHANON (LMT)
Entity Type:Individual
Prefix:
First Name:SHANON
Middle Name:
Last Name:GERRY
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 1:12117 E BOONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:509-926-5678
Mailing Address - Fax:509-328-5268
Practice Address - Street 1:8817 E MISSION AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-5034
Practice Address - Country:US
Practice Address - Phone:509-928-1400
Practice Address - Fax:509-328-5268
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60108110174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist