Provider Demographics
NPI:1396015707
Name:ISAAC, SHELIA BEA (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHELIA
Middle Name:BEA
Last Name:ISAAC
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 1:7808 JEWELLA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-5000
Mailing Address - Country:US
Mailing Address - Phone:318-294-8274
Mailing Address - Fax:
Practice Address - Street 1:7808 JEWELLA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-5000
Practice Address - Country:US
Practice Address - Phone:318-294-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA-5621225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALA-5621OtherSTATE OF LOUISIANA BOARD OF MASSAGE THERAPY