Healthcare Provider Details

I. General information

NPI: 1740705979
Provider Name (Legal Business Name): ALYSON NICOLE SHANKLIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 FURNACE HILLS PIKE
LITITZ PA
17543-8907
US

IV. Provider business mailing address

690 FURNACE HILLS PIKE
LITITZ PA
17543-8907
US

V. Phone/Fax

Practice location:
  • Phone: 717-693-3676
  • Fax: 717-693-3676
Mailing address:
  • Phone: 717-693-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG001776
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier81-3753875
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMASSAGE THERAPY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: