Provider Demographics
NPI:1598440976
Name:SHIMP, ERIN LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:SHIMP
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 1:24960 SW OLD HIGHWAY 99W
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-7302
Mailing Address - Country:US
Mailing Address - Phone:503-539-7877
Mailing Address - Fax:
Practice Address - Street 1:6700 SW 105TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8824
Practice Address - Country:US
Practice Address - Phone:971-399-0415
Practice Address - Fax:971-277-7291
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty