Provider Demographics
NPI:1285794271
Name:SHIELDS, MICHELLE RENEE (LMT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENEE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1030 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027
Mailing Address - Country:US
Mailing Address - Phone:503-722-9760
Mailing Address - Fax:
Practice Address - Street 1:4425 SW CORBETT AVE
Practice Address - Street 2:CORBETT HILL WELLNESS CENTER
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-225-9033
Practice Address - Fax:503-225-9039
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7699225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist