Healthcare Provider Details

I. General information

NPI: 1780894733
Provider Name (Legal Business Name): SHAWNA RENEE TOWNSEND PT, COMT, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

IV. Provider business mailing address

1337 W PEYTON PL
NIXA MO
65714-7173
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-5518
  • Fax:
Mailing address:
  • Phone: 417-425-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2001025951
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number111893
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: