Provider Demographics
NPI:1932444080
Name:BAXTER, SHAUNA L (LMT)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:L
Last Name:BAXTER
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 1:11785 W TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-3349
Mailing Address - Country:US
Mailing Address - Phone:352-634-1219
Mailing Address - Fax:
Practice Address - Street 1:326 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4225
Practice Address - Country:US
Practice Address - Phone:352-634-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 35864225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist