Provider Demographics
NPI:1912138744
Name:PATTERSON, SHAUNDA LYNN (RMT, MMP)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNDA
Middle Name:LYNN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:RMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:FRITCH
Mailing Address - State:TX
Mailing Address - Zip Code:79036-8635
Mailing Address - Country:US
Mailing Address - Phone:806-857-0082
Mailing Address - Fax:
Practice Address - Street 1:200 S MCGEE ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4022
Practice Address - Country:US
Practice Address - Phone:806-273-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT026932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist