Provider Demographics
NPI:1902554959
Name:SHUMATE, VANESSA LINNEA (LMT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LINNEA
Last Name:SHUMATE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LINNEA
Other - Last Name:SHUMATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-0185
Mailing Address - Country:US
Mailing Address - Phone:541-337-3117
Mailing Address - Fax:
Practice Address - Street 1:2791 OAK ALY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3692
Practice Address - Country:US
Practice Address - Phone:541-337-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist