Provider Demographics
NPI:1760849228
Name:HUSKEY, SHAWNNA
Entity Type:Individual
Prefix:
First Name:SHAWNNA
Middle Name:
Last Name:HUSKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWNNA
Other - Middle Name:
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, CLDT
Mailing Address - Street 1:4203 E INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5359
Mailing Address - Country:US
Mailing Address - Phone:602-910-7406
Mailing Address - Fax:
Practice Address - Street 1:4203 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5359
Practice Address - Country:US
Practice Address - Phone:602-910-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-18838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist