Provider Demographics
NPI:1134593825
Name:SHINN, JUDY LEE (LMT)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LEE
Last Name:SHINN
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 1:375 WILD APPLE
Mailing Address - Street 2:
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620-2417
Mailing Address - Country:US
Mailing Address - Phone:509-439-0840
Mailing Address - Fax:
Practice Address - Street 1:146 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620-9588
Practice Address - Country:US
Practice Address - Phone:509-439-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021566225700000X
OR11841225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist