Provider Demographics
NPI:1851419022
Name:SHANKLE, ROCKY LEE (LMT)
Entity Type:Individual
Prefix:MR
First Name:ROCKY
Middle Name:LEE
Last Name:SHANKLE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 UNION TOWN HWY
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956
Mailing Address - Country:US
Mailing Address - Phone:479-471-1582
Mailing Address - Fax:
Practice Address - Street 1:3800 ROGERS AVE
Practice Address - Street 2:STE2
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3046
Practice Address - Country:US
Practice Address - Phone:479-783-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3469225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist