Provider Demographics
NPI:1023465069
Name:WASHINGTON, LOVADA SHAWNTEE (LMT)
Entity type:Individual
Prefix:
First Name:LOVADA
Middle Name:SHAWNTEE
Last Name:WASHINGTON
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 1:611 W ASHLAND AVE APT A
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1234
Mailing Address - Country:US
Mailing Address - Phone:267-503-3013
Mailing Address - Fax:
Practice Address - Street 1:611 W ASHLAND AVE APT A
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1234
Practice Address - Country:US
Practice Address - Phone:267-503-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG010541225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist