Provider Demographics
NPI:1639373137
Name:SHAW, CHRISTINE E (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:E
Last Name:SHAW
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 1:2425 N COURTENAY PKWY
Mailing Address - Street 2:SUITE #8
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4100
Mailing Address - Country:US
Mailing Address - Phone:321-454-2070
Mailing Address - Fax:
Practice Address - Street 1:2425 N COURTENAY PKWY
Practice Address - Street 2:SUITE #8
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4100
Practice Address - Country:US
Practice Address - Phone:321-454-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31088225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA31088OtherPROFESSIONAL LICENSE
FLMM14554OtherESTABLISHMENT LICENSE