Provider Demographics
NPI:1497386718
Name:ALLEN, LAWANDA SHAUNTE' (LMT)
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:SHAUNTE'
Last Name:ALLEN
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 1:3852 GRACELAND DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-5247
Mailing Address - Country:US
Mailing Address - Phone:901-335-6662
Mailing Address - Fax:
Practice Address - Street 1:3852 GRACELAND DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-5247
Practice Address - Country:US
Practice Address - Phone:901-335-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist