MEDICARE: MS. SHELIA BEA ISAAC L.M.T.

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	LA-5621	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LA-5621	OTHER	LA	STATE OF LOUISIANA BOARD OF MASSAGE THERAPY

General Provider Information

NPI Number	:	1396015707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELIA BEA ISAAC L.M.T.

Provider Business Mailing Address
First Line	:	7808 JEWELLA AVE
Second Line	:	SUITE D
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-5000
Country	:	US
Telephone Number	:	318-294-8274
Fax Number	:

Provider Business Practice Location Address
First Line	:	7808 JEWELLA AVE
Second Line	:	SUITE D
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-5000
Country	:	US
Telephone Number	:	318-294-8274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	01/03/2012

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