SHANAVIA NATAE DICKERSON
NPI 1104439975
Massage Therapist in Jonesboro, GA
Active since August 31, 2020
About Shanavia Natae Dickerson NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHANAVIA NATAE DICKERSON (NPI 1104439975) is an individual massage therapist in Jonesboro, Georgia, licensed in Georgia (MT012487) and active in the NPI registry since August 2020.
NPPES Registry Identity
NPI1104439975
Entity TypeIndividualFemale
Primary Taxonomy225700000X
Provider Legal NameSHANAVIA NATAE DICKERSON
Location Address1731 TILDEN AVEJonesboro, GA 30236-3744
Mailing Address1731 Tilden AveJonesboro, GA 30236-3744 · (470) 549-5131
Phone(470) 549-5131
Sole ProprietorYes
Enumeration DateAugust 31, 2020
NPPES CertifiedAugust 31, 2020
✔ NPI 1104439975 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225700000X
License✔ Licensed in GA · MT012487
Definition
An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.
1731 TILDEN AVE, Jonesboro, GA 30236
Group Practice 1
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104439975, enumerated as an "individual" on August 31, 2020.
The provider is located at 1731 TILDEN AVE JONESBORO, GA 30236 and the phone number is (470) 549-5131.
Massage Therapist with taxonomy code 225700000X.
