Healthcare Provider Details

I. General information

NPI: 1699546671
Provider Name (Legal Business Name): ALL MANUAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24076 SE STARK ST STE 310
GRESHAM OR
97030-3386
US

IV. Provider business mailing address

2710 NE 23RD ST
GRESHAM OR
97030-3143
US

V. Phone/Fax

Practice location:
  • Phone: 503-440-0942
  • Fax:
Mailing address:
  • Phone: 503-440-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHINNEAKA KAUFMANN
Title or Position: OFFICE DIRECTOR / MASSAGE THERAPIST
Credential: LMT
Phone: 503-440-0942