Provider Demographics
NPI:1134856909
Name:BOYLES, SHANNON MCARTHUR (LMT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MCARTHUR
Last Name:BOYLES
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 1:6512 SE 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-7626
Mailing Address - Country:US
Mailing Address - Phone:503-490-4254
Mailing Address - Fax:
Practice Address - Street 1:2262 N ALBINA AVE STE 162
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1793
Practice Address - Country:US
Practice Address - Phone:503-490-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26354225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist