Provider Demographics
NPI:1366087454
Name:BRIGGS, SHELBY RYAN (LMT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:RYAN
Last Name:BRIGGS
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 1:151 SANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8620
Mailing Address - Country:US
Mailing Address - Phone:360-996-4940
Mailing Address - Fax:
Practice Address - Street 1:34 NE BOISTFORT ST STE 104
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2600
Practice Address - Country:US
Practice Address - Phone:360-508-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60999466225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist