Provider Demographics
NPI:1578214581
Name:BARNES, SHANNON L (LMT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:BARNES
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 1:5938 ASHWORTH RD
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7110
Mailing Address - Country:US
Mailing Address - Phone:515-238-0630
Mailing Address - Fax:
Practice Address - Street 1:5938 ASHWORTH RD
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7110
Practice Address - Country:US
Practice Address - Phone:515-238-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist