=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548932890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON MARIE REUTER LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2021
-----------------------------------------------------
Last Update Date | 10/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7686 PARK AVE
-----------------------------------------------------
City | LOWVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13367-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-290-5935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7686 PARK AVE
-----------------------------------------------------
City | LOWVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13367-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-290-5935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------