Individual
MRS. SHANNON JOANNE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3101 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3009
(503) 221-3429
(503) 294-3240
Mailing address
3101 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3009
(503) 221-3429
(503) 294-3240
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2972
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2972
—
OR
Enumeration date
09/13/2010
Last updated
09/13/2010
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