Provider Demographics
NPI:1871827394
Name:SHIELDS, LINDA P (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:P
Last Name:SHIELDS
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 1:186 APRIL WATERS DR W
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8832
Mailing Address - Country:US
Mailing Address - Phone:936-788-3444
Mailing Address - Fax:
Practice Address - Street 1:2105 MAUREL
Practice Address - Street 2:SUITE 121
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1231
Practice Address - Country:US
Practice Address - Phone:936-788-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT101024225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist