Provider Demographics
NPI:1801302849
Name:ALL, SHAWNA L (LMT)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:L
Last Name:ALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:SHAWNA
Other - Middle Name:L
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1711
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:971-331-4777
Mailing Address - Fax:
Practice Address - Street 1:24 SE EMIGRANT AVE.
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:971-331-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18055305S00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No305S00000XManaged Care OrganizationsPoint of Service