MEDICARE: SHAWNA ROBERTSON LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019005740	VA

General Provider Information

NPI Number	:	1871141028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA ROBERTSON LMT

Provider Business Mailing Address
First Line	:	762 INDEPENDENCE BLVD STE 100C
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6250
Country	:	US
Telephone Number	:	757-268-6211
Fax Number	:

Provider Business Practice Location Address
First Line	:	762 INDEPENDENCE BLVD STE 100C
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6250
Country	:	US
Telephone Number	:	757-268-6211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	08/30/2019

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Directions to “ SHAWNA ROBERTSON LMT” Practice Location

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