Provider Demographics
NPI:1700026424
Name:KENT, SHAWNA ELIZABETH (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:ELIZABETH
Last Name:KENT
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 1:141 JERGO RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6086
Mailing Address - Country:US
Mailing Address - Phone:407-927-9323
Mailing Address - Fax:
Practice Address - Street 1:12301 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 118
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4508
Practice Address - Country:US
Practice Address - Phone:407-218-4660
Practice Address - Fax:407-218-4661
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA23785225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist