Provider Demographics
NPI:1104377902
Name:PEUHS, SHELLIE (LMT)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:PEUHS
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 1:949 JENKS AVE
Mailing Address - Street 2:15
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2580
Mailing Address - Country:US
Mailing Address - Phone:850-716-2706
Mailing Address - Fax:
Practice Address - Street 1:949 JENKS AVE
Practice Address - Street 2:15
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2580
Practice Address - Country:US
Practice Address - Phone:850-716-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA77148225700000X
FLMM35786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist