MEDICARE: BRENDA ELIZABETH SHUNN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1275825739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENDA ELIZABETH SHUNN

Provider Business Mailing Address
First Line	:	2111 DICKSON DR STE 22
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-4788
Country	:	US
Telephone Number	:	512-797-7688
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 DICKSON DR STE 22
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-4788
Country	:	US
Telephone Number	:	512-797-7688
Fax Number	:

Authorized Official
Title or Position	:	INDEPENDENT PRACTITIONER
Name	:	MS. BRENDA SHUNN
Credential	:	LPT, RMT
Telephone Number	:	512-707-7688

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	05/03/2011

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