Individual
LA SHAWNDA MARIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4048 N ATTU ST, PORTLAND, OR 97203-2059
(503) 757-5786
Mailing address
4048 N ATTU ST, PORTLAND, OR 97203-2059
(503) 757-5786
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21643
OR
Other
Enumeration date
02/29/2016
Last updated
02/29/2016
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