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NPI Code Detail

MEDICARE: SVETLANA SHUBINA LMT

MEDICARE: SVETLANA SHUBINA LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist15310OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115310OTHERORLMT

General Provider Information

NPI Number : 1134453624
Entity Type Code : Individual
Provider Name (Legal Business Name) : SVETLANA SHUBINA LMT
Provider Business Mailing Address
First Line : 7145 SW SAGERT ST
Second Line : 104
City : TUALATIN
State : OR
Zip : 97062-8244
Country : US
Telephone Number : 503-888-3980
Fax Number :
Provider Business Practice Location Address
First Line : 4055 SW GARDEN HOME RD
Second Line :
City : PORTLAND
State : OR
Zip : 97219-3664
Country : US
Telephone Number : 503-888-3980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2009
Last Update Date : 09/30/2009

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