Individual
LANE MARTY SHOCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
600 NW 11TH ST, SUITE E31, HERMISTON, OR 97838-8605
(541) 667-3657
(541) 667-3659
Mailing address
600 N.W 11TH, SUITE E31, HERMISTON, OR 97838
(541) 667-3657
(541) 667-3659
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09190
OR
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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