Provider Demographics
NPI:1811358450
Name:PARIS, STEPHANIE PINDER (LMT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:PINDER
Last Name:PARIS
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 1:2195 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1805
Mailing Address - Country:US
Mailing Address - Phone:503-702-7742
Mailing Address - Fax:
Practice Address - Street 1:4200 MERCANTILE DR
Practice Address - Street 2:#750
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3597
Practice Address - Country:US
Practice Address - Phone:503-305-7762
Practice Address - Fax:503-387-5148
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20904225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist