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General NPI Number Information
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NPI Number | 1316553977
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Entity Type | Individual
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Provider Name | SHAWNEE DEAN TITUS
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Gender | Female
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 404 SWANEE DR APT A
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City | AUSTIN
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State | TX
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Zip | 78752-3018
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Country | US
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Telephone | 832-691-2771
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Fax |
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Provider Business Mailing Address
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Address Line | 404 SWANEE DR APT A
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City | AUSTIN
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State | TX
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Zip | 78752-3018
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Country | US
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Telephone |
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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 | MT131357
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License Number State | TX
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