Provider Demographics
NPI:1740917210
Name:HARRIS, SHEWENDOLYN ELAINE (LMT)
Entity type:Individual
Prefix:
First Name:SHEWENDOLYN
Middle Name:ELAINE
Last Name:HARRIS
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 1:217 JONES ST APT 208
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4060
Mailing Address - Country:US
Mailing Address - Phone:615-930-4695
Mailing Address - Fax:
Practice Address - Street 1:217 JONES ST APT 208
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4060
Practice Address - Country:US
Practice Address - Phone:615-930-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA9593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty