Doctor Name: | SHALLON ANDREA CHURCH |
NPI Number: | 1720499155 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.M.T., R.C.R |
License Number: | 3283 |
Business Practice Address: | 1171 East Highway 11-e Suite 102 Talbott, TN - 37877 |
Business Phone Number: | 4237378020 |
Business Fax Number: | |
Mailing Address: | 1171 East Highway 11-e, Suite 103 TALBOTT |
State: | TN |
Postal Code: | 37877 |
Phone Number: | 4237378020 |
Fax Number: | |
NPI Enumeration Date: | 05/20/2014 |
NPI Last Update Date: | 05/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 3283 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |