Provider Demographics
NPI:1215050760
Name:STEVESON, SHAWNA (LMT)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:STEVESON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2631
Mailing Address - Country:US
Mailing Address - Phone:602-265-1774
Mailing Address - Fax:602-265-1738
Practice Address - Street 1:3201 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2631
Practice Address - Country:US
Practice Address - Phone:602-265-1774
Practice Address - Fax:602-265-1738
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT04448225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist