Provider Demographics
NPI:1588089122
Name:MUSSER, SHELBY (LMP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MUSSER
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 1:1018 E WISHKAH ST # 335
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2937
Mailing Address - Country:US
Mailing Address - Phone:360-533-8848
Mailing Address - Fax:
Practice Address - Street 1:501 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-3924
Practice Address - Country:US
Practice Address - Phone:360-533-8848
Practice Address - Fax:360-532-0385
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60386034225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist