Provider Demographics
NPI:1588023501
Name:REECE, SHAWNA (LMT)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:REECE
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:PO BOX 2609
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0919
Mailing Address - Country:US
Mailing Address - Phone:541-350-2053
Mailing Address - Fax:
Practice Address - Street 1:1205 HIGHWAY 2 STE 304A
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2734
Practice Address - Country:US
Practice Address - Phone:541-350-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22003225700000X
IDMAS-4161225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist