Provider Demographics
NPI:1427333103
Name:SHOEMAKER, REYNIE L (LMP)
Entity type:Individual
Prefix:
First Name:REYNIE
Middle Name:L
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 SE ELLIS CT
Mailing Address - Street 2:STE. 290
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-8598
Mailing Address - Country:US
Mailing Address - Phone:360-535-9155
Mailing Address - Fax:
Practice Address - Street 1:1616 SE ELLIS CT
Practice Address - Street 2:STE 290
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-8598
Practice Address - Country:US
Practice Address - Phone:360-535-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60250475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist