Provider Demographics
NPI:1649776402
Name:WHITNEY, SHANDA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:LYNN
Last Name:WHITNEY
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 1:29606 73RD AVENUE CT S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-4518
Mailing Address - Country:US
Mailing Address - Phone:253-225-9163
Mailing Address - Fax:
Practice Address - Street 1:29606 73RD AVENUE CT S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580-4518
Practice Address - Country:US
Practice Address - Phone:253-225-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60014635225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist