Provider Demographics
NPI:1154296820
Name:TIPPS, SHANICE (MT147709)
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:
Last Name:TIPPS
Suffix:
Gender:F
Credentials:MT147709
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 MARKVILLE DR APT 4135
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3550
Mailing Address - Country:US
Mailing Address - Phone:469-618-3434
Mailing Address - Fax:
Practice Address - Street 1:9030 MARKVILLE DR APT 4135
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3550
Practice Address - Country:US
Practice Address - Phone:469-618-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT147709225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist