MEDICARE: SHANNA RAE PARKER MT

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	19413	CA

General Provider Information

NPI Number	:	1578162343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNA RAE PARKER MT

Provider Business Mailing Address
First Line	:	4226 E 4TH ST APT 1
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-4927
Country	:	US
Telephone Number	:	562-380-7044
Fax Number	:

Provider Business Practice Location Address
First Line	:	4226 E 4TH ST APT 1
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-4927
Country	:	US
Telephone Number	:	562-380-7044
Fax Number	:

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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Directions to “ SHANNA RAE PARKER MT” Practice Location

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