Healthcare Provider Details

I. General information

NPI: 1689480097
Provider Name (Legal Business Name): JAMES SHREEVE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 100
GILBERT AZ
85234-2467
US

IV. Provider business mailing address

2451 E BASELINE RD STE 100
GILBERT AZ
85234-2467
US

V. Phone/Fax

Practice location:
  • Phone: 480-304-5152
  • Fax:
Mailing address:
  • Phone: 480-304-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-30415
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: