Provider Demographics
NPI:1972341352
Name:REEVES, SHAWNDREA (LMT)
Entity type:Individual
Prefix:
First Name:SHAWNDREA
Middle Name:
Last Name:REEVES
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 1:67 PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3978
Mailing Address - Country:US
Mailing Address - Phone:614-222-0019
Mailing Address - Fax:614-222-0021
Practice Address - Street 1:67 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3978
Practice Address - Country:US
Practice Address - Phone:614-222-0019
Practice Address - Fax:614-222-0021
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist