Provider Demographics
NPI:1558860429
Name:CAIN, SHALLON (LMT)
Entity Type:Individual
Prefix:
First Name:SHALLON
Middle Name:
Last Name:CAIN
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 1:300 PALMETTO PARK BLVD APT 113
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7876
Mailing Address - Country:US
Mailing Address - Phone:303-856-5390
Mailing Address - Fax:
Practice Address - Street 1:5339 SUNSET BLVD STE E
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8713
Practice Address - Country:US
Practice Address - Phone:803-567-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS.9803R225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty