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General NPI Number Information
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NPI Number | 1265053995
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Entity Type | Individual
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Provider Name | SHANNON LEE DAVIS LMT4652
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Gender | Female
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 5752 HIGHWAY 72
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City | KILLEN
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State | AL
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Zip | 35645-8242
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Country | US
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Telephone | 256-272-1895
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Fax |
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Provider Business Mailing Address
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Address Line | 3740 HIGHWAY 101
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City | ROGERSVILLE
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State | AL
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Zip | 35652-2601
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Country | US
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Telephone | 256-702-4213
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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 | 4652
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License Number State | AL
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