Provider Demographics
NPI:1841273794
Name:CHAMPOUX, SHIRLEY JEAN (LMP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:CHAMPOUX
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Gender:F
Credentials:LMP
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Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:SUITE 201 THERAPEUTIC ASSOCAITES INC
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:4957 LAKEMONT BLVD SE
Practice Address - Street 2:SUITE C3 TAI LAKEMONT PHYSICAL THERAPY
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-7801
Practice Address - Country:US
Practice Address - Phone:425-401-8406
Practice Address - Fax:425-401-8458
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMA0004641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist