Shane Stark, MEDICAL MASSAGE LMT - Portland, OR

Shane Stark, MEDICALMASSAGELMT

Massage Therapist in Portland, Oregon

NPI 1205593191

Shane Stark is a Massage Therapist based in Portland, OR. Shane Stark practices in Portland, OR and has the professional credentials of MEDICALMASSAGELMT. The NPI Number for Shane Stark is 1205593191 and holds a License No. 19432 (Oregon).

The current practice location address for Shane Stark is 6700 E Burnside St, Portland, OR and can be reached out via phone at 503-627-7243.

Location: 6700 E Burnside St, Portland, OR, 97215-1051

NPI Number

1205593191

Provider Name

Shane Stark

Credential

MEDICALMASSAGELMT

Provider Entity Type

Individual

Gender

Male

Address

6700 E Burnside St, Portland, OR, 97215-1051

Phone Number

503-627-7243

Fax Number

Provider Enumeration Date

11/26/2021

Last Update Date

03/10/2024

Identifier	Type	State	Issuer
19432	01	OR	19432

Address

6700 E Burnside St

City

Portland

State

Oregon

Zip

97215-1051

Phone Number

503-627-7243

Fax Number

Address

6700 E Burnside St

City

Portland

State

Oregon

Zip

97215-1051

Phone Number

503-627-7243

Fax Number

Type

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Classification

Massage Therapist

Speciality

Taxonomy

225700000X

License No.

19432 (Oregon)

Definition

An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

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