Provider Demographics
NPI:1154665610
Name:SHORTTE, DANITA
Entity Type:Individual
Prefix:MRS
First Name:DANITA
Middle Name:
Last Name:SHORTTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W RANCIER AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-3200
Mailing Address - Country:US
Mailing Address - Phone:254-423-7543
Mailing Address - Fax:
Practice Address - Street 1:710 W RANCIER AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-3200
Practice Address - Country:US
Practice Address - Phone:254-423-7543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXME2475225700000X
TXMT112821225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist