Provider Demographics
NPI:1992094452
Name:NEAL, SHAWNTINA LASHAWN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:SHAWNTINA
Middle Name:LASHAWN
Last Name:NEAL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
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Mailing Address - Street 1:706 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1612
Mailing Address - Country:US
Mailing Address - Phone:219-836-8890
Mailing Address - Fax:
Practice Address - Street 1:706 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1612
Practice Address - Country:US
Practice Address - Phone:219-836-8892
Practice Address - Fax:219-836-2244
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT209001009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INMT209001009OtherLICENSE NUMBER