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General NPI Number Information
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NPI Number | 1255126314
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Entity Type | Individual
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Provider Name | SHANEISE MANAIZA MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 630 PROMENADE PL SUITE 17 SUITE 407
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-704-4297
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Fax |
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Provider Business Mailing Address
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Address Line | 1141 DEEP CREEK RD
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-5705
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Country | US
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Telephone | 803-521-6180
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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 | 13683
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License Number State | SC
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