Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shane Stark, MEDICALMASSAGELMT

Individual provider Massage Therapist · NPI 1205593191

Shane Stark, MEDICALMASSAGELMT is a Massage Therapist in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2021.

Licensed in
OR
In the registry since
2021

Practice location Address checks out

6700 E Burnside St
Portland, OR 97215-1051
Phone: (503) 627-7243
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Massage Therapist (primary) Taxonomy 225700000X · Licence 19432 (OR)

Record details

NPI number1205593191
Entity typeIndividual (Type 1)
GenderMale
Credentials MEDICALMASSAGELMT
Sole proprietorNo
NPI enumeratedNovember 26, 2021
Last updated in NPPESNovember 26, 2021
Certification dateNovember 26, 2021

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