Active NPI
Shonda R Cannon, LMT
- Massage Therapist
- Phoenix, OR
National Provider Identifier
1386274157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 24313
- Practice address
- 101 Chelsea CT
Phoenix, OR 97535-5738 - Phone
- (541) 497-0136
- NPI assigned
- Jan 21, 2020
- Last updated
- Jan 27, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 24313 | OR | Primary |
Addresses
Primary practice location
101 Chelsea CT
Phoenix, OR 97535-5738
Mailing address
101 Chelsea CT
Phoenix, OR 97535-5738
Phone (541) 497-0136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24313 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Balanced Massage, LLC | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611705600000",
"number": "1386274157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 CHELSEA CT",
"city": "PHOENIX",
"state": "OR",
"postal_code": "975355738",
"telephone_number": "541-497-0136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 CHELSEA CT",
"city": "PHOENIX",
"state": "OR",
"postal_code": "975355738",
"telephone_number": "541-497-0136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "SHONDA",
"middle_name": "R",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-21",
"last_updated": "2021-01-27",
"certification_date": "2021-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "24313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.