SUSAN SHIVELY LMT
NPI 1871126995
Massage Therapist in Fort Wayne, IN

Q: What is the provider's specialty?

The provider's specialty is Massage Therapist with taxonomy code 225700000X.

Active since February 17, 2020

4606 W JEFFERSON BLVD, FORT WAYNE, IN 46804(260) 459-1111 Get Directions Write a Review

NPPES record last updated: February 17, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Susan Shively Lmt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUSAN SHIVELY LMT (NPI 1871126995) is an individual massage therapist in Fort Wayne, Indiana, licensed in Indiana (MT21907005) and active in the NPI registry since February 2020.

NPPES Registry Identity

NPI1871126995

Entity TypeIndividualFemale

Primary Taxonomy225700000X

Provider Legal NameSUSAN SHIVELYCredential: LMT

Location Address4606 W JEFFERSON BLVDFort Wayne, IN 46804-6826

Mailing Address4606 W Jefferson BlvdFort Wayne, IN 46804-6826 · (260) 459-1111

Phone(260) 459-1111

Sole ProprietorNo

Enumeration DateFebruary 17, 2020

✔ NPI 1871126995 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 IN · MT21907005

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.

4606 W JEFFERSON BLVD, Fort Wayne, IN 46804

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