Provider Demographics
NPI:1922337260
Name:SHIDLER, LYNNE B (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:B
Last Name:SHIDLER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37808 SR 54
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-5428
Mailing Address - Country:US
Mailing Address - Phone:813-713-3982
Mailing Address - Fax:
Practice Address - Street 1:37808 SR 54
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-5428
Practice Address - Country:US
Practice Address - Phone:813-713-3982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#52561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist