Provider Demographics
NPI:1548497290
Name:SHINE INTEGRATIVE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SHINE INTEGRATIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:KATHARINE
Authorized Official - Last Name:SOINEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-901-5361
Mailing Address - Street 1:11735 NW HOLLY SPRINGS LN UNIT 105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6484
Mailing Address - Country:US
Mailing Address - Phone:503-715-7237
Mailing Address - Fax:503-715-0496
Practice Address - Street 1:11735 NW HOLLY SPRINGS LN UNIT 105
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6484
Practice Address - Country:US
Practice Address - Phone:503-715-7237
Practice Address - Fax:503-715-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR58516098261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy