Healthcare Provider Details

I. General information

NPI: 1164554499
Provider Name (Legal Business Name): SHANA SCHONBERG DAVIS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANA ALICIA SCHONBERG LMT

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 SE INTERNATIONAL WAY
MILWAUKIE OR
97222
US

IV. Provider business mailing address

4420 NE 77TH AVE
PORTLAND OR
97218
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-0073
  • Fax: 503-659-7471
Mailing address:
  • Phone: 503-493-2622
  • Fax: 503-493-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7111
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: