Provider Demographics
NPI:1679352819
Name:MURPHY, SHANNON MARGARET (PTA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARGARET
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARGARET
Other - Last Name:NEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 N HIGHLANDS PKWY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2116
Practice Address - Country:US
Practice Address - Phone:253-752-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160932452225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant