Healthcare Provider Details

I. General information

NPI: 1326864018
Provider Name (Legal Business Name): SHANNONS BODYWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28936 OLD TOWN FRONT ST STE 206
TEMECULA CA
92590-2890
US

IV. Provider business mailing address

28936 OLD TOWN FRONT ST STE 206
TEMECULA CA
92590-2890
US

V. Phone/Fax

Practice location:
  • Phone: 951-397-6772
  • Fax:
Mailing address:
  • Phone: 951-498-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHANNON LONG
Title or Position: MASSAGE THERAPIST
Credential:
Phone: 951-498-5821