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General NPI Number Information
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NPI Number | 1336410448
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Entity Type | Individual
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Provider Name | DANIEL JEROME SHUMWAY L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 3033 W. BELL RD STE 101-A
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City | PHOENIX
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State | AZ
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Zip | 85023
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Country | US
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Telephone | 602-375-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 2216 W KRISTAL WAY
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City | PHOENIX
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State | AZ
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Zip | 85027-5123
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Country | US
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Telephone | 480-205-1528
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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 | MT-13598
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License Number State | AZ
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