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General NPI Number Information
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NPI Number | 1609753383
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Entity Type | Individual
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Provider Name | MICHAEL NELSON SHAW LMT
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Gender | Male
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Dates
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Enumeration Date | 08/16/2025
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 225 2ND ST NW
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City | CLEVELAND
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State | TN
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Zip | 37311-5014
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Country | US
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Telephone | 228-348-0009
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Fax |
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Provider Business Mailing Address
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Address Line | 9171 SIR CHARLES CT
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City | HARRISON
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State | TN
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Zip | 37341-3102
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Country | US
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Telephone | 228-348-0009
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Fax | 228-348-0009
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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 | 14034
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License Number State | TN
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