Healthcare Provider Details

I. General information

NPI: 1326936634
Provider Name (Legal Business Name): JULIA ELIZABETH SHACKELFORD MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6791 OVERHILLS RD
SPRING LAKE NC
28390-8873
US

IV. Provider business mailing address

98 WATERS EDGE DR
ERWIN NC
28339-8668
US

V. Phone/Fax

Practice location:
  • Phone: 910-704-2220
  • Fax:
Mailing address:
  • Phone: 910-890-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21674
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: