Provider Demographics
NPI:1376134064
Name:ALLMACHER, SHANA REBECCA (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:REBECCA
Last Name:ALLMACHER
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 1:6175 BALBOA ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-8840
Mailing Address - Country:US
Mailing Address - Phone:970-213-9109
Mailing Address - Fax:
Practice Address - Street 1:6175 BALBOA ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-8840
Practice Address - Country:US
Practice Address - Phone:970-213-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty