Provider Demographics
NPI:1235668930
Name:SHEDD, ERIC (LMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SHEDD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 WYLIE AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3532
Mailing Address - Country:US
Mailing Address - Phone:208-596-5267
Mailing Address - Fax:
Practice Address - Street 1:113 W FRONT ST STE 112
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4332
Practice Address - Country:US
Practice Address - Phone:208-596-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist