Provider Demographics
NPI:1417694043
Name:SHAWNEE, JA'NET MARIE (LMTI, PTP)
Entity Type:Individual
Prefix:
First Name:JA'NET
Middle Name:MARIE
Last Name:SHAWNEE
Suffix:
Gender:F
Credentials:LMTI, PTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 ELAND DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-3906
Mailing Address - Country:US
Mailing Address - Phone:830-929-8484
Mailing Address - Fax:
Practice Address - Street 1:18838 STONE OAK PKWY STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4179
Practice Address - Country:US
Practice Address - Phone:830-929-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114113225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist