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General NPI Number Information
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NPI Number | 1750329637
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Entity Type | Individual
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Provider Name | SHAWN EDWARD NICHOLS RMT
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 433 BROAD ST
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City | COLUMBIA
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State | MS
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Zip | 39429-3038
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Country | US
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Telephone | 601-444-0030
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Fax | 601-444-0033
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Provider Business Mailing Address
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Address Line | 404 S 22ND AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7315
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Country | US
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Telephone | 601-606-6064
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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 | MT645
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License Number State | MS
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