Healthcare Provider Details

I. General information

NPI: 1801711346
Provider Name (Legal Business Name): SHANEA DAWN L HARRIS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 N MAIN ST
LOGAN UT
84321-3935
US

IV. Provider business mailing address

528 N MAIN ST
LOGAN UT
84321-3935
US

V. Phone/Fax

Practice location:
  • Phone: 435-557-9676
  • Fax:
Mailing address:
  • Phone: 435-557-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number136405204701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: