Provider Demographics
NPI:1265668875
Name:AWBREY, JIM SHANE (LMT)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:SHANE
Last Name:AWBREY
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 1:4309 DEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2508
Mailing Address - Country:US
Mailing Address - Phone:940-642-4538
Mailing Address - Fax:
Practice Address - Street 1:2611 PLAZA PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3886
Practice Address - Country:US
Practice Address - Phone:940-642-4538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT023444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist