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General NPI Number Information
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NPI Number | 1104642172
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Entity Type | Individual
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Provider Name | SAMANTHA SHETTERS LMT
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Gender | Female
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 810 HENDERSON ST
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City | ROCKPORT
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State | TX
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Zip | 78382-6829
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Country | US
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Telephone | 361-245-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 533 S MCCAMPBELL ST
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City | ARANSAS PASS
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State | TX
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Zip | 78336-2415
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Country | US
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Telephone | 361-904-3057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT134091
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License Number State | TX
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