Provider Demographics
NPI:1912705633
Name:BUSH, SHAWNA LYN (LMT)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LYN
Last Name:BUSH
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 S 72ND ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-1238
Mailing Address - Country:US
Mailing Address - Phone:253-475-6779
Mailing Address - Fax:253-475-7005
Practice Address - Street 1:1702 S 72ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1238
Practice Address - Country:US
Practice Address - Phone:253-475-6779
Practice Address - Fax:253-475-7005
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61611950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist