Provider Demographics
NPI:1447457460
Name:PURTYMUN, SHARON LOUISE (LMT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LOUISE
Last Name:PURTYMUN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 CROOKED FINGER RD NE
Mailing Address - Street 2:
Mailing Address - City:SCOTTS MILLS
Mailing Address - State:OR
Mailing Address - Zip Code:97375-9622
Mailing Address - Country:US
Mailing Address - Phone:503-385-4669
Mailing Address - Fax:
Practice Address - Street 1:602 FRONT ST.
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381
Practice Address - Country:US
Practice Address - Phone:503-873-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist