Provider Demographics
NPI:1154499028
Name:SHANKLAND, KATHERINE L (LMT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:SHANKLAND
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 1:243 N PLUMOSA ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3468
Mailing Address - Country:US
Mailing Address - Phone:321-223-2587
Mailing Address - Fax:
Practice Address - Street 1:243 N PLUMOSA ST
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3468
Practice Address - Country:US
Practice Address - Phone:321-449-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist