MEDICARE: SHANNA HEARD

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	20850	NC

General Provider Information

NPI Number	:	1811765506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNA HEARD

Provider Business Mailing Address
First Line	:	4905 MCCLURE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-7811
Country	:	US
Telephone Number	:	704-222-5345
Fax Number	:

Provider Business Practice Location Address
First Line	:	4905 MCCLURE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-7811
Country	:	US
Telephone Number	:	704-222-5345
Fax Number	:

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

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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Directions to “ SHANNA HEARD ” Practice Location

Language	Start Address	Practice Location

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