Provider Demographics
NPI:1760699771
Name:MATSUNAGA, SHAWN (ATC,CSHE)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MATSUNAGA
Suffix:
Gender:M
Credentials:ATC,CSHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6557 SUNGATE DR S
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-3105
Mailing Address - Country:US
Mailing Address - Phone:901-377-1435
Mailing Address - Fax:
Practice Address - Street 1:6557 SUNGATE AVE.
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-3105
Practice Address - Country:US
Practice Address - Phone:901-377-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT6312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer