Provider Demographics
NPI:1689486292
Name:LORD, SHANNON R (LMT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:LORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2031 SE BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2812
Mailing Address - Country:US
Mailing Address - Phone:503-893-2275
Mailing Address - Fax:
Practice Address - Street 1:2031 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2812
Practice Address - Country:US
Practice Address - Phone:503-893-2275
Practice Address - Fax:971-512-9545
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT-24918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist