Healthcare Provider Details

I. General information

NPI: 1902701196
Provider Name (Legal Business Name): LISA SHAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11594 CONOVER RD
VERSAILLES OH
45380-8423
US

IV. Provider business mailing address

1399 HILLSIDE DR
GREENVILLE OH
45331-2728
US

V. Phone/Fax

Practice location:
  • Phone: 937-564-7424
  • Fax:
Mailing address:
  • Phone: 937-621-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: